AMSTERDAM – Functional disability remains a significant problem for people with rheumatoid arthritis, with the prevalence remaining at least 15% higher over time than in individuals without the disease.
Sara Freeman/MDedge News
Dr. Elena Myasoedova
“We found a higher prevalence of functional disability in patients with RA versus non-RA,” the presenting study investigator Elena Myasoedova, MD, PhD, said at the European Congress of Rheumatology.
Dr. Myasoedova, who is a clinical fellow in rheumatology at the Mayo Clinic in Rochester, Minn., added that the increase in prevalence over time was significantly higher in subjects with RA than in those without RA (P = .003), but that there was no difference in the pace of this increase with adjustment for the duration of RA disease (P = .51).
There was also no difference in functional disability between the two groups of patients by about the 8th or 9th decade.
RA remains one of the most common conditions associated with functional disability, Dr. Myasoedova said, with several risk factors for physical impairment identified, including being female, of older age, smoking, and the use of certain medications (glucocorticoids and antidepressants), as well as sociodemographic factors.
A discrepancy between improved RA disease control and persistent impairment in physical function has been noted in prior studies, but there are few data on how this might change over time. Dr. Myasoedova and her associates investigated this by analyzing data from the Rochester Epidemiology Project, which collects medical data on individuals living in Olmsted County, Minnesota. They identified two populations of adults aged 18 and older: one diagnosed with RA according to 1987 American College of Rheumatology criteria between 1999 and 2013, and one without RA but who were of a similar age and sex and enrolled in the project around the same time.
As part of the project, participants completed an annual questionnaire asking about their health and ability to perform six activities of daily living (ADL). These include the ability to wash, dress, feed, and toilet oneself without assistance, as well as perform normal household chores and walk unaided. Over the course of study, 7,466 questionnaires have been completed by the participants and functional disability was defined as having difficulty with at least one of these six ADLs, Dr. Myasoedova explained.
At baseline, subjects with and without RA were aged a mean of 55 and 56 years, respectively, and 70% in both groups were female. Similar percentages were current (about 15%), former (about 30%), or never smokers (about 55%), and about 40% were obese.
Just under two-thirds (64.4%) of patients in the RA cohort were positive for rheumatoid factor (RF) or anti–cyclic citrullinated peptide (CCP) antibodies. While there was a similar prevalence of functional disability in RA patients who were or were not RF or CCP positive (both 25%, P = .67), there was an increasing prevalence noted in those who were positive versus those who were negative over time (P = .027).
Although the investigators did not conduct an objective assessment for functional disability, these findings highlight the need for vigilant management of patients with RA, Dr. Myasoedova proposed.
“Early and aggressive treatment regimens aimed at tight inflammation control can help prevent the disabling effects of high disease activity and joint damage, thereby lowering functional disability,” she said in an interview ahead of the congress.
Future work, she observed, should look at how the pattern of functional disability changes and the use of transition modeling to understand the bidirectional pattern of potential change and accumulation of functional disability in RA. The investigators also plan to look at risk factors for persistent and worsening functional disability and how treatment – including “treat to target” and biologics – might affect this.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases supported the study. Dr. Myasoedova had no conflicts of interest.
SOURCE: Myasoedova E et al. Ann Rheum Dis. 2018;77(Suppl 2):54. Abstract OP0009.