Patients with rheumatoid arthritis who achieved recommended targets on measures of disease activity functioned better, had better quality of life, and used fewer health care resources, compared with patients with low disease activity levels, according to researchers.
Relevant targets included scoring 3.3 or less on the Simplified Disease Activity Index (SDAI), 2.8 or less on the Clinical Disease Activity Index (CDAI), and less than 2.6 on the Disease Activity Score in 28 joints using C-reactive protein (DAS28-CRP), said Dr. Evo Alemao of Bristol-Myers Squibb, Princeton, N.J., and associates. If patient-clinician teams cannot meet these targets, they should aim for low levels of disease activity because higher levels were associated with even worse physical functioning and health-related quality of life, they said.
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Clinical studies have increasingly focused on target measures of RA activity, but their short durations and highly adherent, severely affected patient populations have limited generalizability, the investigators noted. To bridge the gap, they analyzed outcomes data from the observational, longitudinal, prospective Brigham and Women’s Hospital Rheumatoid Arthritis Sequential Study, which has followed almost 1,300 RA patients seen at a single hospital center for up to 5 years.
The average age of the patients was 56 years. They had experienced RA symptoms for a median of 15 years (Arthritis Care Res. (Hoboken) 2015 Aug 3 doi: 10.1002/acr.22678). In the controlled analysis, patients who met recommended SDAI and CDAI targets functioned better physically than did those with low disease activity (average improvement on the Modified Health Activity Questionnaire, .047 and .073, respectively; P values, .01 and .0003), the researchers reported. The DAS28-CRP target did not show that effect, but all three targets were linked to better EQ-5D scores compared with low, moderate, or high disease activity (range of improvement, .022 to .096; P less than .003).
Furthermore, patients who met recommended targets were 36%-45% less likely to be hospitalized (P less than .05) and 23%-45% less likely to report using durable medical equipment (P less than .01) than were patients with residual disease activity, the researchers said.
Future work should look at relationships between target measures and pain, fatigue, and Total Sharp Score outcomes, and also should analyze cost data, the investigators said.
Bristol-Myers Squibb funded the study and write-up, and Crescendo Bioscience and UCB funded the BRASS Registry. Dr. Alemao reported being employed by BMS. Four coauthors reported financial ties with BMS, Amgen, AbbVie, Genentech, Crescendo Bioscience, Medimmune, and UCB. The rest reported having no conflicts of interest.