Disease-modifying drugs may not be effective in long-term RA therapy

NEW YORK (Reuters Health) – Results of a 10-year prospective study indicate that patients with rheumatoid arthritis (RA) have excess mortality and deteriorating function despite continuous treatment with disease-modifying drugs, UK researchers report.

Dr. Terence Gibson from Guy's Hospital, London, and colleagues collected data on 289 RA patients who remained on disease-modifying drugs such as methotrexate, sulfasalazine, and azathioprine during 10 years of follow-up. During the period, 71 patients died for a standardized mortality rate of 1.302. Ninety-two patients were alive but not available for follow-up, according to the report in the November issue of the Journal of Rheumatology.

At baseline and at 5 and 10 years, median joint tenderness, morning stiffness, grip strength, and hemoglobin did not significantly differ, and although the erythrocyte sedimentation rate decreased, the decrease was not significant, the researchers found.

However, during the study, Health Assessment Questionnaire scores decreased (p = 0.004). Radiographs of hands and feet also showed a deteriorating condition (p = 0.001). Worsening radiographs were seen in patients with short, medium and long histories of RA, and "correlations between disability, radiographic scores and joint tenderness were apparent at the start and conclusion of the study," Dr. Gibson's group reports.

By the end the study, 19% of the patients had undergone joint surgery with 15% having at least one large joint replaced. Women were significantly more likely to undergo joint replacement (p = 0.02), the UK team notes.

"It was in 1988 that Pincus suggested that short-term studies may give rise to false expectations, and that radiological and laboratory values are overemphasized at the expense of long-term outcomes of functional status and death," Dr. Gibson and colleagues comment. "Perhaps our study serves to reinforce this message."

J Rheumatol 2001;28:2409-2415.

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