Rheumatoid arthritisHas rheumatoid arthritis become a milder disease?
Section editors:
Franco Di Padova – Novartis, Basel, Switzerland
Valerie Quesniaux – Transgenose Institute, CNRS, Orleans, France
Introduction
The question, whether rheumatoid arthritis (RA) has become a less severe disease, was first raised two decades ago by Silman et al. [1] when they observed a decline in rheumatoid factor seropositivity and in the frequency of erosions and nodules among referrals for RA to the London Rheumatology department in the 1970s.
Rheumatoid arthritis is typically a progressive, inflammatory disease with a prevalence of 0.5–1% [2] and an incidence of 25–50/100,000 [3]. Recent advances in the treatment with disease-modifying antirheumatic drugs (DMARD) and indications of a decreasing incidence poses the question whether RA patients have a lighter disease burden today than a few decades ago. The purpose of this paper is to review data that indicate an improved disease severity and discuss possible causes for such an improvement. Such knowledge would enable policy makers in healthcare to consider whether investments in new and expensive therapies are reflected in a better overall health in RA.
Section snippets
Advances in treatment
Advances in treatment have been achieved in many areas, including recognition of early and aggressive use of DMARDs, opportunities to tailor therapy according to prognostic markers and access to new and more effective drugs (Table 1).
Awareness that DMARDs should be used aggressively in patients with RA is increasing in the rheumatologic community. Ward and Fries [4] reported that the proportion of RA patients treated with DMARD increased from 1981 to 1996 from 32 to 47% in a group of 305
Has the disease improved?
Documentation of improved long-term outcome requires long-term observational data over many years in addition to randomized controlled clinical trials of short duration. Potential outcomes for improvement of RA in a longitudinal aspect include survival, need for joint replacement surgery, radiographic damage and health status.
Conclusions
Data from different sources (mortality, surgery, radiographic damage, health status) support that the burden of RA has become lighter today compared with that decades ago. Changes in epidemiological characteristics such as a shift in the incidence to an older age, changes in diagnostic criteria or improved socioeconomic conditions in the population might be explanatory factors. However, this improvement in health and disease burden seems first of all to be related to better treatment strategies
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