Earlier, more aggressive RA treatment produces better outcomes than 20 years ago

Individuals diagnosed with rheumatoid arthritis (RA) more recently experienced decreased disability and psychological problems than those treated 20 years ago. While treatment strategies have helped, researchers attribute the positive effects to greater physical activity and encouragement of a worthwhile life by healthcare professionals.

Cecile L. Overman, MSc, and colleagues of the Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands, reported in Arthritis Care & Research that reduced disease activity in patients with RA can be attributed to earlier diagnosis and more intensive pharmacological treatment as well as physical activity.

From 1990 to 2008, more than 1,100 patients with RA were monitored at diagnosis and then after 3 to 5 years of treatment. Depression, anxiety, and physical disability were predicated in multiple linear regression analyses.

Psychological distress was assessed with the Impact of Rheumatic diseases on General health and Lifestyle questionnaire. Patient functional status was assessed using the Disability Index of the Health Assessment Questionnaire. Disease activity was assessed with erythrocyte sedimentation rate (ESR) in mm/hour (Westergren) and the Thompson articular index with a range of 0-534.

The authors suggest that both improvements in drug treatment and nonpharmacological management could be responsible for the favorable trends of psychological distress and physical disability witnessed after the first years of treatment by reducing disease activity during the last 20 years. However, they ascribe that the education of rheumatologists and health professionals stressing the need for physical activity and encouragement to lead a “valued life” were also instrumental in relieving psychological distress and physical disability.

“Percentages of patients with depressed mood, anxiety, and physical disability at follow-up changed from 25%, 23%, and 53% two decades ago [1994-1998] to 14%, 12%, and 31% nowadays [2007-2011]. After taking account of reduction in disease activity, the decrease of physical disability remained significant (P<.001),” the researchers wrote.

“In conclusion, in this population of patients with a recent RA diagnosis, psychological distress and physical disability reduced significantly over the last two decades. This favorable trend might be partly due to a decrease in disease activity. The research findings indicated that it is easier to live a valued life while having RA nowadays than 20 years ago,” they said.