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#497875 - 11/29/13 04:53 PM RA - Impact of Disease Activity
MollyC1i Offline
Very_Addicted_to_AS_Kickin

Registered: 01/21/04
Posts: 9702
Loc: Brittany, France (since Nov 08...
http://ard.bmj.com/content/early/2013/11/29/annrheumdis-2013-204021.full#sec-12

Ann Rheum Dis doi:10.1136/annrheumdis-2013-204021
Clinical and epidemiological research
Extended report

Mortality in rheumatoid arthritis: the impact of disease activity, treatment with glucocorticoids, TNFα inhibitors and rituximab
Open Access

Annals of the Rheumatic Diseases
Abstract
Objectives To investigate the impact of disease activity, the course of the disease, its treatment over time, comorbidities and traditional risk factors on survival.

Methods Data of the German biologics register RABBIT were used. Cox regression was applied to investigate the impact of time-varying covariates (disease activity as measured by the DAS28, functional capacity, treatment with glucocorticoids, biologic or synthetic disease modifying antirheumatic drugs (DMARDs)) on mortality after adjustment for age, sex, comorbid conditions and smoking.

Results During 31&#8197;378 patient-years of follow-up, 463 of 8908 patients died (standardised mortality ratio: 1.49 (95% CI 1.36 to 1.63)). Patients with persistent, highly active disease (mean DAS28&#8201;&#8201;>&#8201;5.1) had a significantly higher mortality risk (adjusted HR (HRadj)=2.43; (95% CI 1.64 to 3.61)) than patients with persistently low disease activity (mean DAS28&#8201;<&#8201;3.2). Poor function and treatment with glucocorticoids >&#8197;5&#8197;mg/d was significantly associated with an increased mortality, independent of disease activity. Significantly lower mortality was observed in patients treated with tumour necrosis factor &#945; (TNF&#945;) inhibitors (HRadj=0.64 (95% CI 0.50 to 0.81), rituximab (HRadj=0.57 (95% CI 0.39 to 0.84), or other biologics (HRadj=0.64 (95% CI 0.42 to 0.99), compared to those receiving methotrexate. To account for treatment termination in patients at risk, an HRadj for patients ever exposed to TNF&#945; inhibitors or rituximab was calculated. This resulted in an HRadj of 0.77 (95% CI 0.60 to 0.97).

Conclusions Patients with long-standing high disease activity are at substantially increased risk of mortality. Effective control of disease activity decreases mortality. TNF&#945; inhibitors and rituximab seem to be superior to conventional DMARDs in reducing this risk.

cat

Full report available - open access.
_________________________
MollyC1i - Riding OutAS

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#497891 - 11/29/13 08:48 PM Re: RA - Impact of Disease Activity [Re: MollyC1i]
Shirley Offline
Second_Degree_AS_Kicker

Registered: 08/23/12
Posts: 215
Loc: New Zealand
Thanks Molly that's really interesting.

Hopefully one day they'll do a similar study for AS but I can't think of any reason why the findings wouldn't apply to that too. I do worry a bit about the long term elevation in my CRP levels, although treatment has reduced it quite a bit.
_________________________
AS, IBS, reflux oesophagitis and dysphagia, PCOS/insulin resistance, asthma...
Currently managing my AS with humira, methotrexate, low starch diet and exercises. Also taking omeprazole, metformin etc.

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