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Comparative Study
. 2018 Jun;77(6):848-854.
doi: 10.1136/annrheumdis-2017-212426. Epub 2018 Feb 23.

Have the 10-year outcomes of patients with early inflammatory arthritis improved in the new millennium compared with the decade before? Results from the Norfolk Arthritis Register

James M Gwinnutt  1 , Deborah P M Symmons  1 , Alexander J MacGregor  2   3 , Jacqueline R Chipping  2   3 , Tarnya Marshall  2   3 , Mark Lunt  1 , Suzanne M M Verstappen  1   4
Affiliations
Comparative Study

Have the 10-year outcomes of patients with early inflammatory arthritis improved in the new millennium compared with the decade before? Results from the Norfolk Arthritis Register

James M Gwinnutt et al. Ann Rheum Dis. 2018 Jun.

Abstract

Objective: To compare the 10-year outcome (disease activity, disability, mortality) of two cohorts of patients with inflammatory polyarthritis (IP) recruited 10 years apart.

Methods: Patients with IP were recruited to the Norfolk Arthritis Register from 1990 to 1994 (cohort 1 (C1)) and from 2000 to 2004 (cohort 2 (C2)). Demographic and clinical data were collected at baseline and at years 1, 2, 3, 5, 7 and 10. Longitudinal disease activity (swollen/tender 51 joint counts (SJC51/TJC51)) and disability (Health Assessment Questionnaire (HAQ)) were compared between the cohorts using population-average negative binomial regression and generalised estimating equation analysis, respectively. Risk of 10-year mortality was compared between cohorts using Cox models. Risk of cardiovascular disease (CVD) mortality was compared between cohorts using competing risks analysis. Mortality rate ratios (MRR), adjusted for changes in mortality risk of the general population, were calculated using Poisson regression.

Results: In total 1653 patients were recruited (C1=1022, C2=631). Patients in C2 had 17% lower SJC51 than C1 over 10 years (95% CI -23% to -10%), whereas TJC51 and HAQ were comparable. C2 patients had reduced risk of all-cause and CVD mortality compared with C1 (all-cause: HR 0.72, 95% CI 0.56 to 0.95; CVD: subhazard ratio 0.58, 95% CI 0.37 to 0.93). After accounting for changes in mortality risk in the general population, the difference in mortality was non-significant (all-cause: MRR 0.78, 95% CI 0.56 to 1.10; CVD: MRR 0.77, 95% CI 0.48 to 1.24).

Conclusion: Disease activity significantly improved in the new millennium, whereas disability and mortality were unchanged.

Keywords: disability; early rheumatoid arthritis; epidemiology; mortality; outcomes research.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Outcome over 10 years stratified by cohort: (A) median swollen joint count 51, (B) median tender joint count 51, (C) median Health Assessment Questionnaire (HAQ) score and (D) Kaplan-Meier survival curve (adjusted for age and gender (age centred at 70 years)).
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