Enhanced treatment strategies and distinct disease outcomes among autoantibody-positive and -negative rheumatoid arthritis patients over 25 years: A longitudinal cohort study in the Netherlands

by Xanthe M. E. Matthijssen, Ellis Niemantsverdriet, Tom W. J. Huizinga, Annette H. M. van der Helm –van Mil BackgroundBased on different genetic and environmental risk factors and histology, it has been proposed that rheumatoid arthritis (RA) consists of 2 types: autoantibody-positive and autoantibody-negative RA. However, until now, this remained hypothetical. To assess this hypothesis, we studied whether the long-term outcomes differed for these 2 groups of RA patients. Methods and findingsIn the Leiden Early Arthritis Clinic cohort, 1,285 consecutive RA patients were included between 1993 and 2016 and followed yearly. Treatment protocols in routine care improved over time, irrespective of autoantibody status, and 5 inclusion periods were used as instrumental variables: 1993 –1996, delayed mild disease-modifying antirheumatic drug (DMARD) initiation (reference period); 1997–2000, early mild DMARDs; 2001–2005, early methotrexate; 2006–2010, early methotrexate followed by treat-to-target adjustments; 2011–2016, similar to 2006–2010 plus additional efforts for very early referral. Three long-term outcomes were studied: sustained DMARD-free remission (SDFR) (persistent absence of clinical synovitis after DMARD cessation), mortality, and functional disability measured by yearly Health Assessment Questionnaire (HAQ). Treatment response in the short term (dis ease activity) was measured by Disease Activity Score–28 with erythrocyte sedimentation rate (DAS28-ESR). ...
Source: PLoS Medicine - Category: Internal Medicine Authors: Source Type: research