Re: RESEARCH - Tight control of RA might reduce subsequent disability

[Guest guest]

Very helpful information. Thanks for taking the time. This makes me

feel better about taking methotrexate - ..

Carol

On Nov 29, 2005, at 2:17 PM, wrote:

> Tight control of RA might reduce subsequent disability

>

>

> Rheumawire

> November 29, 2005

> Janis

>

>

> San Diego, CA - Tight control of rheumatoid-arthritis (RA) disease

> activity

> is emerging as a key strategy for preventing the progression of

> RA-related

> disability. In data presented at the 2005 ACR/ARHP Annual Scientific

> Meeting:

>

>

> 1. Dr Hisashi Yamanaka (Tokyo Women's Medical University, Japan)

> reported

> that tight control of disease activity (to Disease Activity Score 28

> [DAS28]

> <3.2) can prevent disability progression, but moderate control does

> not [1].

>

> 2. Dr Eiichi Tanaka (Tokyo Women's Medical University) suggested that

> tight control and improved RA disease activity levels are likely to

> translate into reduced long-term medical costs [2].

>

> 3. Dr Theodore Pincus (Vanderbilt University, Nashville, TN) reported

> that tighter control of inflammation by earlier use of methotrexate

> (MTX)

> resulted in better clinical status over 10 years [3].

>

>

> Taken together, these studies suggest that " tight control " is likely

> to

> become standard practice in RA because it prevents disability, saves

> money,

> and improves clinical status.

>

>

> Early MTX, aggressive disease control prevent disability

>

> The Yamanaka and Tanaka presentations used data from a prospective

> observational cohort of more than 6000 RA patients. Clinical data were

> collected biannually and included the patient's self report, physician

> assessment, and laboratory data. Yamanaka's analysis included 1940

> patients,

> with an average disease duration of 10.3 years.

>

> " Several recent clinical researchers have emphasized the necessity of

> the

> tight control of disease activity for the prevention of structural

> damage in

> patients with RA. Most of these studies were investigated in

> randomized

> controlled trials [RCTs]; however, the results of RCTs are sometimes

> unsuitable to apply directly in daily practice. To investigate the

> necessity

> of the tight control of disease activity in daily practice, we

> investigated

> the relationship between the disease activity and the progression of

> disability in a large observational cohort of RA patients, " Yamanaka

> said.

>

> Patients were divided into three groups based on the average DAS28

> over the

> previous four years. These were poorly controlled (average DAS28

> >5.1),

> moderately controlled (average DAS28 2.3-5.1) and well controlled

> (average

> DAS28 <3.2). Progression of disability was assessed using the Japanese

> version of the Health Assessment Questionnaire (J-HAQ).

>

> " Over the past 4.5 years we observed a dramatic improvement in DAS28

> scores

> and changes in the medications used, " Yamanaka said. " This included a

> dramatic increase in use of methotrexate and a decrease in use of

> prednisone. We think that the widespread use of higher doses of

> methotrexate

> resulted in these improvements. "

>

> HAQ score and DAS28 score were closely related at baseline. In the

> poorly

> controlled group, the HAQ increased from 1.43 to 1.68 over the trial

> period.

> HAQ scores also increased from 0.88 to 1.00 in the patients with

> moderately

> controlled disease activity.

>

> " On the other hand, in the well-controlled group, the HAQ score was

> 0.40 at

> entry and 0.37 at four years, indicating that disability was not

> getting

> worse and was getting better in some patients, those whose average

> DAS28 was

> <2.6, whose HAQ improved from 0.294 to 0.249. Tight control of disease

> activity prevented the progression of disability in daily practice, "

> Yamanaka concluded.

>

> Tanaka noted that this has not yet translated into a net saving in

> costs of

> care, but he expects the significant improvements in DAS28 (p<0.0001)

> to

> lead to reductions in medical costs over the long term.

>

> " The average outpatient cost gradually increased (+8% in 4.5 years)

> from

> ¥267 259 [approximately US $2236] per year in 2000 to ¥289 375

> [approximately US $2420] per year in 2004. Medications accounted for

> about

> 50% of total outpatient cost, which increased 31% during the 4.5 years

> observed. Infusion costs increased with the introduction of infliximab

> (+223% per 4.5 years), " Tanaka said.

>

> It is interesting to note that the improvements in patients studied by

> Tanaka and Yamanaka occurred without the use of biologics. Tanaka

> said that

> only about 3% of RA patients in Japan receive biologics.

>

> Similarly, Pincus reported that earlier use of methotrexate in the

> standard

> care of RA patients is becoming more common and is associated with

> better

> clinical status.

>

> This analysis used two databases of RA patients seen in Jyvaskyla,

> Finland

> and Nashville, TN. The database was analyzed in five-year periods for

> time

> from presentation to initiation of methotrexate, number of years of

> follow-up, and proportion of patients treated with methotrexate in

> each

> period. Time to beginning methotrexate declined from 14 years during

> 1980-84

> to 0.5 years in 2000-2004 in the Finnish patients and similarly in the

> American ones, but early methotrexate use was adopted five to 10 years

> earlier in Nashville than in Jyvaskyla. Clinical status over time

> improved

> in both populations.

>

> " Improved [erythrocyte sedimentation rate] ESR, HAQ, and

> [Multidimensional

> Health Assessment Questionnaire] MHAQ scores were seen over these

> periods,

> associated with aggressive therapy both in a higher proportion of

> patients

> and earlier onset of MTX use, although a secular trend toward milder

> disease

> may also be present. These data suggest that the strategy to use MTX

> early

> in disease may be as important as the drug itself in the management

> of RA, "

> Pincus concluded.

>

>

>             Sources

>

>             1. Yamanaka H, Inoue E, Tanaka E, et al. Tight

controls of

> the disease activity successfully prevent the progression of

> disability in a

> large observational cohort of rheumatoid arthritis patients in Japan.

> 2005

> ACR/ARHP Annual Scientific Meeting; November 12-17, 2005; San Diego,

> CA.

> Abstract 1181.

>              2. Tanaka E, Kamitsuji S, Inoue E, et al. Tight

control

> of

> the disease activity may lead to reduced medical costs for care of

> patients

> with rheumatoid arthritis-analysis of medical cost for care using a

> large

> cohort database. 2005 ACR/ARHP Annual Scientific Meeting; November

> 12-17,

> 2005; San Diego, CA. Abstract 553

>              3. Pincus T, Sokka T. Toward " tight control " of

> inflammation

> in patients with rheumatoid arthritis: Earlier use of methotrexate in

> standard care of patients with RA in 2 settings in the US and Finland

> over

> 25 years, 1980-2004, associated with improved clinical status. 2005

> ACR/ARHP

> Annual Scientific Meeting; November 12-17, 2005; San Diego, CA.

> Abstract

> 894.

>

>

>

>

>

>

> Not an MD

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>

>

>

>