Exploring the disparity between inflammation and disability in the 10-year outcomes of people with rheumatoid arthritis

Gwinnutt, James M., Norton, Sam, Hyrich, Kimme L., Lunt, Mark, Combe, Bernard, Rincheval, Nathalie, Ruyssen-Witrand, Adeline, Fautrel, Bruno, McWilliams, Daniel F., Walsh, David A., Nikiphorou, Elena, Kiely, Patrick, Young, Adam, Chipping, Jacqueline R., MacGregor, Alex ORCID: https://orcid.org/0000-0003-2163-2325 and Verstappen, Suzanne M. M. (2022) Exploring the disparity between inflammation and disability in the 10-year outcomes of people with rheumatoid arthritis. Rheumatology, 61 (12). 4687–4701. ISSN 1462-0324

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Objectives: To identify groups of people with RA with different disability trajectories over 10 years, despite comparable levels of inflammation. Methods: Data for this analysis came from three European prospective cohort studies of people with RA [Norfolk Arthritis Register (NOAR), Early RA Network (ERAN), Étude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR)]. Participants were assessed regularly over 8 (ERAN) to 10 (NOAR/ESPOIR) years. Inclusion criteria were: recruited after 1 January 2000, <24 months baseline symptom duration, and disability (HAQ) and inflammation [two-component DAS28 (DAS28-2C)] recorded at baseline and at one other follow-up. People in each cohort also completed patient-reported outcome measures at each assessment (pain, fatigue, depressive symptoms). Group-based trajectory models were used to identify distinct groups of people with similar HAQ and DAS28-2C trajectories over follow-up. Results: This analysis included 2500 people with RA (NOAR: 1000, ESPOIR: 766, ERAN: 734). ESPOIR included more women and the participants were younger [mean (standard deviation) age: NOAR: 57.1 (14.6), ESPOIR: 47.6 (12.5), ERAN: 56.8 (13.8); women: NOAR: 63.9%, ESPOIR: 76.9%, ERAN: 69.1%). Within each cohort, two pairs of trajectories following the hypothesized pattern (comparable DAS28-2Cs but different HAQs) were identified. Higher pain, fatigue and depressive symptoms were associated with increased odds of being in the high HAQ trajectories. Conclusion: Excess disability is persistent in RA. Controlling inflammation may not be sufficient to alleviate disability in all people with RA, and effective pain, fatigue and mood management may be needed in some groups to improve long-term function.

Item Type: Article
Additional Information: Funding: This work was supported by the Medical Research Council (through a Skills Development Fellowship for J.M.G.), Versus Arthritis (grant number 21755) and the NIHR Manchester Biomedical Research Centre and the NIHR Nottingham Biomedical Research Centre. The ESPOIR cohort was supported by an unrestricted grant from Merck Sharp and Dohme (MSD) allocated for the first 5 years. Two additional grants from INSERM were obtained to support part of the biological database. The French Society of Rheumatology, Abbvie, Pfizer, Lilly, and more recently Fresenius and Galapagos also supported the ESPOIR cohort study. The ERAN cohort was supported by unrestricted grants from Wyeth Pharmaceuticals, and the UK Healthcare Commission supported creation of the ERAN database. Data availability statement: The data underlying this article cannot be shared publicly for the privacy of individuals who participated in the study. The data will be shared on reasonable request to the principal investigators of each of the three datasets (NOAR: A.M., ERAN: D.A.W., ESPOIR: B.C.).
Uncontrolled Keywords: ra,disability,epidemiology,outcomes research,psychology,rheumatology,pharmacology (medical) ,/dk/atira/pure/subjectarea/asjc/2700/2745
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 31 Mar 2022 11:30
Last Modified: 15 Dec 2022 03:21
URI: https://ueaeprints.uea.ac.uk/id/eprint/84397
DOI: 10.1093/rheumatology/keac137

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