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Impact of intensive treatment and remission on health-related quality of life in early and established rheumatoid arthritis

OBJECTIVES: To establish if using intensive treatment to reduce synovitis and attain remission in active rheumatoid arthritis (RA) improves all aspects of health-related quality of life (HRQoL). METHODS: A secondary analysis of two randomised clinical trials (CARDERA and TACIT) was undertaken. CARDE...

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Autores principales: Scott, I C, Ibrahim, F, Lewis, C M, Scott, D L, Strand, V
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013499/
https://www.ncbi.nlm.nih.gov/pubmed/27651924
http://dx.doi.org/10.1136/rmdopen-2016-000270
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author Scott, I C
Ibrahim, F
Lewis, C M
Scott, D L
Strand, V
author_facet Scott, I C
Ibrahim, F
Lewis, C M
Scott, D L
Strand, V
author_sort Scott, I C
collection PubMed
description OBJECTIVES: To establish if using intensive treatment to reduce synovitis and attain remission in active rheumatoid arthritis (RA) improves all aspects of health-related quality of life (HRQoL). METHODS: A secondary analysis of two randomised clinical trials (CARDERA and TACIT) was undertaken. CARDERA randomised 467 patients with early active RA to different disease-modifying antirheumatic drug (DMARD) regimens, including high-dose tapering corticosteroids. TACIT randomised 205 established patients with active RA to combination DMARDs (cDMARDs) or tumour necrosis factor-α inhibitors (TNFis). Short-Form 36 (SF-36) measured HRQoL across eight domains, generating physical (PCS) and mental (MCS) component summary scores. Linear regression evaluated 6-month intensive treatment impacts. Mean SF-36 scores, stratified by end point disease activity category, were compared with age/gender-matched population scores. RESULTS: In CARDERA, intensive corticosteroid treatment gave significantly greater improvements in PCS but not MCS scores relative to placebo. In TACIT, all eight SF-36 domains had improvements from baseline exceeding minimal clinically important differences with cDMARDs and TNFis. Significantly greater improvements with TNFi relative to cDMARDs were reported in PCS only (p=0.034), after adjusting for covariates. Remission provided the best SF-36 profiles, but scores in physical functioning, role physical and general health in both trials remained below normative values. Patient global assessment of disease activity had a greater association with HRQoL than other disease activity score (DAS28) components. CONCLUSIONS: Intensive corticosteroid treatment in early RA improves physical but not mental health, relative to placebo. In established RA, cDMARDs and TNFi provide similar improvements in HRQoL. As remission optimises but fails to normalise HRQoL, a focus on treatment strategies targeting HRQoL is required. TRIAL REGISTRATION NUMBERS: CARDERA was registered as ISRCTN 32484878. TACIT was registered as ISRCTN 37438295; pre-results.
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spelling pubmed-50134992016-09-20 Impact of intensive treatment and remission on health-related quality of life in early and established rheumatoid arthritis Scott, I C Ibrahim, F Lewis, C M Scott, D L Strand, V RMD Open Rheumatoid Arthritis OBJECTIVES: To establish if using intensive treatment to reduce synovitis and attain remission in active rheumatoid arthritis (RA) improves all aspects of health-related quality of life (HRQoL). METHODS: A secondary analysis of two randomised clinical trials (CARDERA and TACIT) was undertaken. CARDERA randomised 467 patients with early active RA to different disease-modifying antirheumatic drug (DMARD) regimens, including high-dose tapering corticosteroids. TACIT randomised 205 established patients with active RA to combination DMARDs (cDMARDs) or tumour necrosis factor-α inhibitors (TNFis). Short-Form 36 (SF-36) measured HRQoL across eight domains, generating physical (PCS) and mental (MCS) component summary scores. Linear regression evaluated 6-month intensive treatment impacts. Mean SF-36 scores, stratified by end point disease activity category, were compared with age/gender-matched population scores. RESULTS: In CARDERA, intensive corticosteroid treatment gave significantly greater improvements in PCS but not MCS scores relative to placebo. In TACIT, all eight SF-36 domains had improvements from baseline exceeding minimal clinically important differences with cDMARDs and TNFis. Significantly greater improvements with TNFi relative to cDMARDs were reported in PCS only (p=0.034), after adjusting for covariates. Remission provided the best SF-36 profiles, but scores in physical functioning, role physical and general health in both trials remained below normative values. Patient global assessment of disease activity had a greater association with HRQoL than other disease activity score (DAS28) components. CONCLUSIONS: Intensive corticosteroid treatment in early RA improves physical but not mental health, relative to placebo. In established RA, cDMARDs and TNFi provide similar improvements in HRQoL. As remission optimises but fails to normalise HRQoL, a focus on treatment strategies targeting HRQoL is required. TRIAL REGISTRATION NUMBERS: CARDERA was registered as ISRCTN 32484878. TACIT was registered as ISRCTN 37438295; pre-results. BMJ Publishing Group 2016-08-26 /pmc/articles/PMC5013499/ /pubmed/27651924 http://dx.doi.org/10.1136/rmdopen-2016-000270 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Rheumatoid Arthritis
Scott, I C
Ibrahim, F
Lewis, C M
Scott, D L
Strand, V
Impact of intensive treatment and remission on health-related quality of life in early and established rheumatoid arthritis
title Impact of intensive treatment and remission on health-related quality of life in early and established rheumatoid arthritis
title_full Impact of intensive treatment and remission on health-related quality of life in early and established rheumatoid arthritis
title_fullStr Impact of intensive treatment and remission on health-related quality of life in early and established rheumatoid arthritis
title_full_unstemmed Impact of intensive treatment and remission on health-related quality of life in early and established rheumatoid arthritis
title_short Impact of intensive treatment and remission on health-related quality of life in early and established rheumatoid arthritis
title_sort impact of intensive treatment and remission on health-related quality of life in early and established rheumatoid arthritis
topic Rheumatoid Arthritis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013499/
https://www.ncbi.nlm.nih.gov/pubmed/27651924
http://dx.doi.org/10.1136/rmdopen-2016-000270
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