ATLANTA — Physical functioning in rheumatoid arthritis patients is affected more by inflammation early in the disease process, and more by structural damage as the disease progresses, according to an analysis of pooled data from two large clinical trials.
“We feel that this study confirms that deterioration of physical functioning as a result of RA may be driven predominantly by inflammation earlier in the course of disease, but over time it is driven more by structural damage than it is by inflammation. It also suggests that earlier treatment of these patients with appropriate therapy prior to development of significant structural damage should dramatically improve the long-term physical function and disability outcomes of our patients with rheumatoid arthritis,” reported Dr. Martin J. Bergman.
Dr. Bergman and his colleagues studied 1,415 patients from the two trials, each of which assessed the effects of adalimumab in RA: The PREMIER (Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery) trial was a double-blind, placebo-controlled phase III trial in patients with early RA, and the DE019 trial was a randomized, placebo-controlled trial of patients with established RA. A total of 908 patients from these trials had a disease duration of 3 years or less, and 507 had a disease duration of greater than 3 years.
“We pooled data to assess the relationship between structural damage as measured by the modified Total Sharp Score, joint space narrowing, and joint erosions. We also looked at inflammation as measured by C-reactive protein,” said Dr. Bergman, who is both on the staff of the division of rheumatology at Drexel University in Philadelphia, and chief of the division of rheumatology at Taylor Hospital of Arthritis and Rheumatology in Ridley Park, Pa.
Physical functioning was assessed using the Health Assessment Questionnaire (HAQ), and the Physical Component Score and Physical Functioning domain of the Short Form (SF)-36 Questionnaire, which assesses quality of life, he said.
Spearman's correlation coefficients showed a significant relationship between all three measures of physical function and C-reactive protein in early RA, but no correlation between those measures and a modified Total Sharp Score (mTSS).
In patients with longstanding RA, the measures of function were significantly correlated with mTSS and with CRP – although the latter associations were weaker than those seen in early disease, Dr. Bergman concluded.
http://www.rheumatologynews.com/article/S1541-9800(11)70100-4/fulltext