NIHR | Manchester Biomedical Research Centre

Evidence suggests patients with early inflammatory arthritis now have better outcomes compared with previous decades

New research from The University of Manchester in collaboration with researchers at the University of East Anglia shows improved long-term outcomes for patients diagnosed with early inflammatory arthritis, when comparing to the previous 10 year period.

The study led by Dr Suzanne Verstappen (first author Dr James Gwinnutt), looked at data collected by the Norfolk Arthritis Register (NOAR), a study which recruits patients with inflammatory polyarthritis soon after symptoms begin and then follows them over time and completes assessments at pre-specified time intervals.

Inflammatory polyarthritis, which includes rheumatoid arthritis, is a chronic condition associated with inflammation and damage to joints as well as early death. Over the past few decades there have been many advances in the treatment of inflammatory polyarthritis, including the importance of early targeted treatment.

These changes have been shown to improve the lives of patients in the short term, but researchers in Manchester wanted to identify whether these developments in treatment are associated with long-term improvements in patients’ lives.

The research team used data from the Norfolk Arthritis Register and set measures of outcome, including disease activity assessed by number of swollen joints, physical disability and death rate to evaluate long-term improvements. Two groups of patients were compared; those recruited between 2000-04 and those recruited 10 years previously 1990-94.

It was found that patients recruited from 2000-04 had, on average, 17% lower swollen joint counts over the course of 10 years compared to patients with symptom onset 10 years earlier. But the data showed that physical disability of the two groups of patients was similar. When looking at risk of death, patients recruited from 2000-4 had a 28% reduced risk of dying from any cause and a 42% lower risk of dying from cardiovascular disease when compared to patients recruited in 1990-94. Researchers noted that the reduction in risk of death was not over and above what was seen in the general population over the same period.

The results from this study indicate patients diagnosed in the new millennium have lower disease activity over a 10 year period, when compared to those diagnosed in the early 1990s. It’s important to note that this could be due to both better medical care and an increased awareness across the public of the need for healthy living. What is interesting is that this reduction in disease activity has not translated into improvements in disability for patients in the new millennium compared to 10 years previously. More research is needed to better understand what may the reasons that people report the same disability while having less disease activity.

Dr Suzanne Verstappen, Reader at The University of Manchester and part of the NIHR Manchester Biomedical Research Centre,

Further research into this area will be supported in the NIHR Manchester Biomedical Research Centre Musculoskeletal Theme.