RA Significantly Impacts Functional Disability

Individuals with rheumatoid arthritis (RA) have a significantly higher prevalence of functional disability across RA disease duration, age, gender, and calendar time compared with their counterparts without RA, according to findings from a new study.

“The recent decades have been marked with dramatic advancements in treatment of RA,” Elena Myasoedova, MD, PhD, assistant professor of medicine at Mayo Clinic in Rochester, Minnesota, and lead author of the study, told Rheumatology Consultant. “Early initiation of treatment with disease-modifying antirheumatic drugs and the use of biologics have been associated with improved control of RA disease activity. Whether there has been a corresponding improvement in functional disability in RA and how these trends in functional disability compare between RA and the general population is not known,” she said.

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To assess trends in functional disability, Myasoedova and colleagues evaluated responses to questionnaires completed by 586 participants with RA and 531 participants without RA during routine outpatient appointments at Mayo Clinic in Olmsted County, Minnesota.

The participants’ functional disability was measured based on their responses to questions regarding their ability to perform 6 activities of daily living, including dressing and bathing.

“Using extensive resources of the Rochester Epidemiology Project, we were able to compare trends in functional disability in RA to those in the general population,” Myasoedova said.

The results showed that participants with RA had a higher prevalence of functional disability at the RA incidence/index date (26%) compared with those without RA (11%), with persistent excess and no improvement over follow-up and calendar time.

“This lack of improvement contrasts with improved RA disease activity over time as reported by others and prompts the need for further research aiming at investigation of underlying reasons for the lack of improvement in functional disability in RA in the era of advanced therapeutics,” Myasoedova said.

Participants with RA also had a 15% or higher prevalence of functional disability compared with those without RA across any age group younger than 80 years. Those with rheumatoid factor/anti-cyclic citrullinated peptide experienced an increased prevalence of functional disability over the duration of their disease.

In the 2 to 3 years prior to the RA incidence/index date, no statistically significant difference in functional disability between those with and without RA was observed. However, there was a significant difference in prevalence that began when participants were 1 to 2 years from their RA incidence/index date, another finding Myasoedova said was important.

“The excess in functional disability predates RA incidence date, which has not been shown before,” she said.

—Colleen Murphy

Reference:

Myasoedova E, Davis JM III, Achenbach SJ, Matteson EL, Crowson CS. Trends in prevalence of functional disability in rheumatoid arthritis compared with the general population [published online April 30, 2019]. Mayo Clin Proc. doi:10.1016/j.mayocp.2019.01.002.