Health-related quality of life and functional ability in patients with early arthritis during remission steered treatment: results of the IMPROVED studyReportar como inadecuado




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Arthritis Research and Therapy

, 15:R173

First Online: 31 October 2013Received: 06 June 2013Accepted: 11 October 2013

Abstract

IntroductionThe aim of this study was to investigate patient reported outcomes PROs of functional ability and health related quality of life HRQoL in patients with early rheumatoid arthritis during one year of remission steered treatment.

MethodsIn this study, 610 patients with early rheumatoid arthritis RA or undifferentiated arthritis UA were treated with methotrexate MTX and tapered high dose of prednisone. Patients in early remission Disease Activity Score DAS <1.6 after 4 months tapered prednisone to zero and when in persistent remission, also tapered MTX. Patients not in early remission were randomized to either MTX + hydroxychloroquine + sulphasalazine + prednisone arm 1 or to MTX + adalimumab arm 2. Every 4 months, patients filled out the Health Assessment Questionnaire HAQ and the McMaster Toronto Arthritis Patient Preference Questionnaire MACTAR, the Short Form 36 SF-36 and visual analogue scales VAS. Change scores were compared between treatment groups. The association with achieving remission was analyzed using linear mixed models.

ResultsDuring year 1, patients who achieved early remission had the most improvement in PROs with scores comparable to the general population. Patients in the randomization arms showed less improvement. Scores were comparable between the arms. There was a significant association between achieving remission and scores of HAQ, MACTAR and physical HRQoL.

ConclusionsIn early arthritis, PROs of functional ability and HRQoL after one year of remission steered treatment reach normal values in patients who achieved early remission. In patients not in early remission, who were randomized to two strategy arms, PROs improved less, with similar scores in both treatment arms.

Trial registrationsISRCTN11916566 and EudraCT2006-006186-16

AbbreviationsACPAAnticitrullinated protein antibody

ACR-EULARAmerican College of Rheumatology-European League against Rheumatism

ADAAdalimumab

CIConfidence interval

DASDisease activity score

DMARDDisease-modifying antirheumatic drug

HAQHealth assessment questionnaire

HCQHydroxychloroquine

HRQoLHealth-related quality of life

IMPROVEDStudy Induction therapy with Methotrexate and Prednisone in Rheumatoid or Very Early arthritic Disease

MACTARMcMaster Toronto Arthritis Patient Preference Questionnaire

MCSMental component score

MTXMethotrexate

OPOutside protocol

PCSPhysical component score

PROPatient-reported outcome

RARheumatoid arthritis

SF-3636-Item Short Form Health Survey

TNFTumor necrosis factor

UAUndifferentiated arthritis

VASVisual analogue scale

VASdaVisual analogue scale disease activity

VASglVisual analogue scale global health

VASmsVisual analogue scale morning stiffness

VASpainVisual analogue scale pain.

Electronic supplementary materialThe online version of this article doi:10.1186-ar4361 contains supplementary material, which is available to authorized users.

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Autor: Lotte Heimans - Kirsten VC Wevers-de Boer - KK Michel Koudijs - Karen Visser - Yvonne P Goekoop-Ruiterman - Joop B Harb

Fuente: https://link.springer.com/



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