Daniel Aletaha (Medical University of Vienna, Austria) and colleagues searched the literature for RCTs published between 1980 and 2005 that used the Health Assessment Questionnaire Disability Index (HAQ) to assess physical function in RA patient populations with different durations of disease. Forty-two trials met the inclusion criteria; the study treatments included biologic agents, traditional disease-modifying antirheumatic drugs, and placebo. The analysis, which appears in the Annals of the Rheumatic Diseases, showed that the difference in functional improvement between patients on active therapy and placebo was significantly reduced in patients with a longer duration of RA. The HAQ response, adjusted for placebo, fell on average by 0.37 per year of RA duration, the authors estimate. In their discussion, Aletaha and team remark that the "clear functional benefits" of biological therapies seen in early RA "can be completely lost in late RA." Indeed, in patients who have had RA for 10 or more years it may be impossible to discriminate a treatment effect from mere placebo effect. "This supports the concept that physical function has reversible and irreversible components, the latter reducing the responsiveness of any functional measures," Aletaha and co-authors conclude. "In addition our results indicate that comparisons of improvements in physical function between therapeutic interventions and across different RCTs can only be made with careful consideration of the potential for improvement within a specific patient group."
What determines late stage disease. I mean for me my blood work only showed poditive about a year ago. That only means i am sicker. I mean i was stiff as a board for the last eight years. I have had swelling. Come and go flares for many years. They increasingly got closer together. Now the only difference is I flare always constantly. A constant battle. Is anyone else this way? I have heard a few say they tested positive and had never swelled yet? I mean with RA do most of you have to fight it everyday? Did it hit you like a brick. Or was is easier to fight at first? I may have had some AI that was not actually RA first I do not know? But I would have to think it was RA as it attacks all the same places as it used to. Virtually every where. But for example my right shoulder and upper part of c-spine I had been going to orthos and physical therapy for 22 years ago. Then eight years ago the mri's in my orthos opinion was showing systemic RA. My surgeon and a back specialist said the same thing. The back specialist said there was arthritis around my spine and it was actually very bad. My sugeon said there was swelling in my shoulder on the Mri. His note to RD said this is not normal there is not supposed to be swelling of this kind in someones shoulder unless they have RA. Of course I was hurting every where at the time as i do now.
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