Subset of RA patients with high disability, low inflammation identified
medwireNews: Research presented at the EULAR 2021 Virtual Congress has identified a subgroup of patients with rheumatoid arthritis (RA) who have a high degree of disability despite low levels of inflammation.
James Gwinnutt (The University of Manchester, UK) and team used patient data from two registries – NOAR (n=1001) and ESPOIR (n=767) – to evaluate trajectories of disability and inflammation during 10 years of follow-up among patients with less than 2 years of symptom duration at baseline.
In the NOAR cohort, 52.6% of patients were already taking conventional DMARDs at baseline, the average HAQ disability score was 1 point, and the average DAS28 two-component inflammation score (DAS28-2C) was 3 points. Gwinnutt said that in this cohort overall, average HAQ disability scores “gradually increased over time”, whereas DAS28-2C inflammation scores “gradually reduced over time.”
He reported that there was “a different pattern” in the ESPOIR cohort, in which just 6.3% of patients were taking DMARDs prior to study entry. Both disability and inflammation scores reduced rapidly as people started taking DMARDs, and then remained “relatively constant” throughout follow-up. Average HAQ and DAS28-2C scores at baseline were 1 and 4 points, respectively.
The researchers categorized patients from both cohorts into four groups according to their HAQ and DAS28-2C scores over the 10-year period, and the analysis focused on two groups that had “markedly different” levels of disability, representing around a 1-point difference in HAQ score, despite “very similar” trajectories of inflammation.
Gwinnutt and team then compared baseline patient characteristics between these groups to identify predictors of disability.
They found that in NOAR, individuals in the group with higher disability scores were older on average (62.1 vs 54.9 years), comprised a higher proportion of women (73.6 vs 65.3%), and had higher mean pain (4.6 vs 3.7) and fatigue (5.3 vs 4.3) scores on a scale of 0–10 compared with those in the group with lower disability scores. These variables were all significant predictors of disability on logistic regression analysis.
And there was a similar pattern of results in ESPOIR, in which older age, female sex, and fatigue score at baseline were all significant predictors of disability. Pain scores were numerically higher in the high versus low disability group in ESPOIR, but the difference did not reach statistical significance.
Taken together, these findings suggest that “pain and fatigue management strategies are needed […] in order to narrow the gap between long-term inflammation and disability in RA,” concluded Gwinnutt.
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