First, the good news: If you’ve been recently diagnosed with rheumatoid arthritis (RA), there’s a pretty good shot that, with proper treatment, you’ll be able to reach remission or low disease activity. A new study, published in the journal Rheumatology, found that 59 percent of those who were diagnosed in 2010 reached low disease activity within five years. That’s a vast improvement from 1990, when only 32 percent of those who were diagnosed then reached low disease activity within five years.
The not so good news: Improvements in disease activity according to objective measures don’t always mean that RA patients experience less pain and fatigue.
This study relied on data from two large UK-based patient cohorts (the Early Rheumatoid Arthritis Study and the Early Rheumatoid Arthritis Network) that was gathered between 1986 and 2011. Researchers found that although objective measure like swollen joint count and erythrocyte sedimentation rate (ESR) improved over the years, patients’ feedback about their mental health, level of disability, pain, fatigue, and overall perception of their disease activity remained stable.
The authors noted that although available treatment options have improved and expanded over the years, it’s also become more common for RA patients to have additional (comorbid) conditions.
“Whilst it is likely that adoption of more intensive and aggressive treatment strategies are the primary drivers for the decline in inflammatory markers of the disease, it is unclear whether the increases in comorbidities [like cardiovascular disease] and obesity are hampering equal improvements in pain, fatigue, and functional disability,” they wrote.
“The role of improved therapeutic managements has been instrumental in lowering inflammation and reducing the inflammatory aspects of the disease over the last 30 years, the so-called objective markers. However, there is a clear need to examine the subjective aspects of the disease, which is driving the discordance between objective measures of inflammation, and the patient-reported measures,” they concluded.
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Carpenter L, et al. Secular changes in the progression of clinical markers and patient-reported outcomes in early rheumatoid arthritis. Rheumatology. January 2020. doi: https://doi.org/10.1093/rheumatology/kez635.