Rheumatoid Arthritis: Early and Intensive Treatment Reduces Mortality and the Use of Joint Prostheses

According to several studies presented at the European Congress of Rheumatology (EULAR 2018), early and intensive treatment of rheumatoid arthritis improves prognosis, reduces joint damage and normalizes survival.

The results of a 23-year study presented at the European Congress of Rheumatology (Abstract OP0015), EULAR 2018, suggest that early and intensive treatment of rheumatoid arthritis (RA) has long-term benefits, including , a normalization of mortality rates that return to levels comparable to those of the general population.
"Our results confirm that early and intensive treatment of rheumatoid arthritis, including the use of corticosteroids, has long-term benefits," said Professor Maarten Boers, VU University Medical Center, Amsterdam, and author of the study. "Importantly, this study is one of the first to show a normalization of mortality in RA compared to the general population after 23 years of follow-up."

Excess mortality during the PR

Rheumatoid arthritis is a chronic inflammatory disease that affects a person's joints, causing pain and disability. It can also affect the internal organs (lung, heart, kidney). Mortality in patients with RA is higher than in the general population.

Much progress has been made in treatment, which has been associated with a reduction in the complications of the disease, but evidence of improved mortality rates remains debatable.
"We know that the damaging effects of rheumatoid arthritis on the body only really become apparent after more than a decade," said Professor Robert Landewé, Chair of the EULAR Scientific Program Committee. "Therefore, it is really interesting to see these data support early intensive treatment after such a long follow-up period."

23 years of COBRA study follow-up

This prospective study analyzed mortality rates after 23 years of follow-up of the COBRA study (COmbinatietherapie Bij Rheumatoide Artritis) which was an early intensive treatment study. In the initial study, patients with early RA were treated with either sulphalasazine monotherapy or a combination of low-dose sulphalasazine and methotrexate with prednisolone at baseline.

The initial results showed that the combined treatment provided additional control of the disease compared to sulphalasazine alone. In 2010, after 11 years of follow-up, there was also a numerical reduction in mortality (but not significantly) in patients on combined therapy compared with patients on sulphalasazine alone.
The current study analyzed data from 154 of the original 155 patients with an average follow-up time of 23 years (in those who did not die). Using a matched reference sample for age and sex, researchers demonstrated a lower numerical mortality (44/154, 28%) than the general population (55/154, 35%).

Reduced joint damage and the use of joint prostheses

The results of two other studies presented also at the annual European Congress of Rheumatology (SAT0077 and OP0116) show that between 1997 and 2010, the implementation of total hip prostheses decreased by half (-51.9%, p <0.001 ) in the oldest patients with the most severe rheumatoid arthritis.

These data, which cover approximately one million people, are from the Biologics Register of the British Rheumatology Association for Rheumatoid Arthritis (BSRBR / RA).

Cardiac intervention rates did not change significantly over time in both groups, suggesting that the changes observed in prosthetic surgery were due to improvements in the treatment of RA rather than a lack of treatment. access to surgery.

PR: net improvement in care

The management of RA has progressed considerably over the past 25 years, moving from primarily palliative treatment to treatment regimens that have a real impact on disease activity.

This evolution has been multifactorial, with in particular a better use of therapeutic resources already available, but also the provision of biological therapies such as anti-TNF.

"We welcome these results that demonstrate such a reduction in joint replacement surgery in RA patients in recent years," said Professor Robert Landewé, Chair of the Scientific Program Committee, EULAR. "It is also very interesting to see data specifically concerning the impact of biological treatments on this result given the extent of progress in the management of RA during the same period".

Video: SPARC Strategic Planning Workshop: Biology & Technology Day 2 (November 2019).