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Is rheumatoid arthritis really getting less severe?

Abstract

The incidence of rheumatoid arthritis (RA) is decreasing, and rheumatologists perceive that their patients are presenting with less-disabling disease. This impression coincides with the availability of improved therapeutic options, including biologic agents. In RA, the term 'disease severity' can be defined from various perspectives: that of the patient, or by measures of disease activity and damage. This Perspectives article examines the scientific basis for a perceived decrease in RA severity over time, as determined by patient-reported outcomes and measures of disease severity and structural damage. An improved health care system and better treatment strategies with access to new therapeutic modalities are likely to have contributed to a milder RA disease course in more-recent years. The focus needs to be kept on these issues to further improve disease severity in patients with RA.

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References

  1. Smolen, J. S., Aletaha, D., Koeller, M., Weisman, M. H. & Emery, P. New therapies for treatment of rheumatoid arthritis. Lancet 370, 1861–1874 (2007).

    Article  CAS  Google Scholar 

  2. Wolfe, F. & Michaud K. Proposed metrics for the determination of rheumatoid arthritis outcome and treatment success and failure. J. Rheumatol. 36, 27–33 (2009).

    Article  Google Scholar 

  3. van Vollenhoven, R. F. & Klareskog, L. The treatment of rheumatoid arthritis: getting better all the time? Arthritis Rheum. 52, 991–994 (2005).

    Article  Google Scholar 

  4. Welsing, P. M., van Gestel, A. M., Swinkels, H. L., Kiemeney, L. A. & van Riel, P. L. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum. 44, 2009–2017 (2001).

    Article  CAS  Google Scholar 

  5. Welsing, P. M., Fransen, J. & van Riel, P. L. Is the disease course of rheumatoid arthritis becoming milder? Time trends since 1985 in an inception cohort of early rheumatoid arthritis. Arthritis Rheum. 52, 2616–2624 (2005).

    Article  Google Scholar 

  6. Ødegård, S. et al. Association of early radiographic damage with impaired physical function in rheumatoid arthritis: a ten-year, longitudinal observational study in 238 patients. Arthritis Rheum. 54, 68–75 (2006).

    Article  Google Scholar 

  7. Uhlig, T., Heiberg, T., Mowinckel, P. & Kvien, T. K. Rheumatoid arthritis is milder in the new millennium: health status in patients with rheumatoid arthritis 1994–2004. Ann. Rheum. Dis. 67, 1710–1715 (2008).

    Article  CAS  Google Scholar 

  8. Heiberg, T., Finset, A., Uhlig, T. & Kvien, T. K. Seven year changes in health status and priorities for improvement of health in patients with rheumatoid arthritis. Ann. Rheum. Dis. 64, 191–195 (2005).

    Article  CAS  Google Scholar 

  9. Krishnan, E. & Fries, J. F. Reduction in long-term functional disability in rheumatoid arthritis from 1977 to 1998: a longitudinal study of 3,035 patients. Am. J. Med. 115, 371–376 (2003).

    Article  Google Scholar 

  10. Bergstrom, U. et al. Lower disease activity and disability in Swedish patients with rheumatoid arthritis in 1995 compared with 1978. Scand. J. Rheumatol. 28, 160–165 (1999).

    Article  CAS  Google Scholar 

  11. Gordon, P., West, J., Jones, H. & Gibson, T. A 10 year prospective follow-up of patients with rheumatoid arthritis 1986–96. J. Rheumatol. 28, 2409–2415 (2001).

    CAS  PubMed  Google Scholar 

  12. Finckh, A., Choi, H. K. & Wolfe, F. Progression of radiographic joint damage in different eras: trends towards milder disease in rheumatoid arthritis are attributable to improved treatment. Ann. Rheum. Dis. 65, 1192–1197 (2006).

    Article  CAS  Google Scholar 

  13. Pincus, T., Sokka, T. & Kautiainen, H. Patients seen for standard rheumatoid arthritis care have significantly better articular, radiographic, laboratory, and functional status in 2000 than in 1985. Arthritis Rheum. 52, 1009–1019 (2005).

    Article  Google Scholar 

  14. Porter, D. R. et al. Is rheumatoid arthritis becoming a milder disease? Or are we starting second-line therapy in patients with milder disease? Br. J. Rheumatol. 35, 1305–1308 (1996).

    Article  CAS  Google Scholar 

  15. Ødegard, S., Kvien, T. K. & Uhlig, T. Incidence of clinically important 10-year health status and disease activity levels in population-based cohorts with rheumatoid arthritis. J. Rheumatol. 35, 54–60 (2008).

    PubMed  Google Scholar 

  16. Sokka, T., Kautiainen, H., Hakkinen, A. & Hannonen, P. Radiographic progression is getting milder in patients with early rheumatoid arthritis. Results of 3 cohorts over 5 years. J. Rheumatol. 31, 1073–1082 (2004).

    PubMed  Google Scholar 

  17. Krishnan, E. & Fries, J. F. Rheumatoid arthritis: radiographic progression is getting milder. J. Rheumatol. 32, 195 (2005).

    PubMed  Google Scholar 

  18. Sokka, T., Kautiainen, H. & Hannonen, P. Stable occurrence of knee and hip total joint replacement in Central Finland between 1986 and 2003: an indication of improved long-term outcomes of rheumatoid arthritis. Ann. Rheum. Dis. 66, 341–344 (2007).

    Article  Google Scholar 

  19. Turesson, C., O'Fallon, W. M., Crowson, C. S., Gabriel, S. E. & Matteson, E. L. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann. Rheum. Dis. 62, 722–727 (2003).

    Article  CAS  Google Scholar 

  20. Watts, R. A., Mooney, J., Lane, S. E. & Scott, D. G. Rheumatoid vasculitis: becoming extinct? Rheumatology (Oxford) 43, 920–923 (2004).

    Article  CAS  Google Scholar 

  21. Gabriel, S. E. et al. Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthritis Rheum. 48, 54–58 (2003).

    Article  Google Scholar 

  22. Fevang, B. T., Lie, S. A., Havelin, L. I., Engesaeter, L. B. & Furnes, O. Reduction in orthopedic surgery among patients with chronic inflammatory joint disease in Norway, 1994–2004. Arthritis Rheum. 57, 529–532 (2007).

    Article  CAS  Google Scholar 

  23. da Silva, E., Doran, M. F., Crowson, C. S., O'Fallon, W. M. & Matteson, E. L. Declining use of orthopedic surgery in patients with rheumatoid arthritis? Results of a long-term, population-based assessment. Arthritis Rheum. 49, 216–220 (2003).

    Article  Google Scholar 

  24. Silman, A., Davies, P., Currey, H. L. & Evans, S. J. Is rheumatoid arthritis becoming less severe? J. Chronic Dis. 36, 891–897 (1983).

    Article  CAS  Google Scholar 

  25. Jansen, L. M. et al. Comparison of the baseline disease activity of early oligo- and polyarthritis in sequential years. Clin. Exp. Rheumatol. 22, 447–452 (2004).

    CAS  PubMed  Google Scholar 

  26. Irvine, S., Munro, R. & Porter, D. Early referral, diagnosis, and treatment of rheumatoid arthritis: evidence for changing medical practice. Ann. Rheum. Dis. 58, 510–513 (1999).

    Article  CAS  Google Scholar 

  27. Ward, M. M. Decreases in rates of hospitalizations for manifestations of severe rheumatoid arthritis, 1983–2001. Arthritis Rheum. 50, 1122–1131 (2004).

    Article  Google Scholar 

  28. Sokka, T., Abelson, B. & Pincus, T. Mortality in rheumatoid arthritis: 2008 update. Clin. Exp. Rheumatol. 26, S35–S61 (2008).

    CAS  PubMed  Google Scholar 

  29. Krause, D., Schleusser, B., Herborn, G. & Rau, R. Response to methotrexate treatment is associated with reduced mortality in patients with severe rheumatoid arthritis. Arthritis Rheum. 43, 14–21 (2000).

    Article  CAS  Google Scholar 

  30. Choi, H. K., Hernan, M. A., Seeger, J. D., Robins, J. M. & Wolfe, F. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 359, 1173–1177 (2002).

    Article  CAS  Google Scholar 

  31. Sokka, T. et al. Association of in rheumatoid arthritis (RA) disease activity and gross domestic product in 20 countries in the QUEST-RA study. Ann. Rheum. Dis. 66 (Suppl.), 274 (2007).

    Google Scholar 

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Correspondence to Till Uhlig.

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Uhlig, T., Kvien, T. Is rheumatoid arthritis really getting less severe?. Nat Rev Rheumatol 5, 461–464 (2009). https://doi.org/10.1038/nrrheum.2009.140

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