Targeting disease remission has socio-economic benefits over low disease activity

June 19, 2010

Achieving disease remission in patients with rheumatoid arthritis (RA) provides superior outcomes across measures of socio-economic importance including work productivity and quality of life according to results presented today at EULAR 2010, the Annual Congress of the European League Against Rheumatism in Rome, Italy. These Austrian findings are reported in addition to improvements in measures of physical functioning, when compared with RA patients achieving low disease activity (LDA).

Results from this cross-sectional study of 356 patients showed statistically significant differences (p= < 0.01) between ra patients who had achieved disease remission (rem, defined by the clinical disease activity index (cdai), a composite index including objective and patient derived scores) compared to those who had achieved lda across several domains including:

  • Effect on work productivity, based on results of the Work Productivity and Activity Impairment (WPAI*) index: impairment while working 11.3% vs. 27.2%, overall activity impairment 18.1% vs. 33.8%, REM vs LDA respectively
  • Impact on quality of life, based on results of the Euro Qol (5D EQ-5D)* index: 0.89 vs. 0.78 and the SF-36 PCS* index: 46.2 vs. 37.8
  • Impact on physical functioning, based on results of the Health Assessment Questionnaire (HAQ*) scores: 0.38 vs. 0.75.
"We know that RA as a chronic disease often has a long term impact on patients' functional ability, affecting not only patients' well-being but also their working lives. The majority of those affected report a loss of productivity at work, and many even have to stop work altogether," said Dr. Helga Radner, Department of Rheumatology, Medical University Vienna, Austria and lead author of the study. "Our study results show that the benefits of achieving clinical remission are worthwhile, especially from a socio-economic point of view, as it decreases the 'burden of disease' not only for patients but also for society on a wider scale. The findings reveal that remission is even superior to an almost perfect disease activity state, namely low disease activity, therefore our major task in treating RA-patients should be its achievement and maintenance"

Interestingly, researchers found that the emotional aspects of the disease activity measures were similarly reported in patients in remission and in low disease activity indicating that once disease activity or symptom levels are reduced to a certain level, emotional discord may stabilise.

Longitudinal analysis over one year showed significant improvements when comparing the two patient populations in the following areas:

  • Quality of life (EQ-5D); 0.89 vs. 0.80 (REM vs. LDA respectively), p < 0.001
  • Percent of overall activity impairment (WPAI) per year; 12.2% vs. 31.0%, p < 0.001
  • Physical disability (HAQ); 0.23 vs. 0.69, p= < 0.001
Significant differences between REM and LDA were not seen in the domain of percentage impairment while working (8.3% vs. 20.0% (REM vs. LDA respectively), p=0.096).

This study of 356 patients registered at the Department of Rheumatology at the Medical University of Vienna involved one cross sectional analysis (at a single time point) of RA patients, with 34 patients achieving REM (CDAI ≤2.8) and 66 patients achieving LDA (2.8≤CDAI<1).

* HAQ is a disability index used by physicians to measure an individual's physical functioning and assesses ability to undertake everyday activities such as dressing, eating and walking, and whether assistance from another person or disability aids is required. A higher score indicates greater disability.

The WPAI questionnaire measures work time missed and work and activity impairment due to a specified health problem during the last 7 days.

The (EQ-5D) is a health-related quality of life scale consisting of five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) to which responses can be made at three levels of severity (no problems/some or moderate problems/extreme problems).

The Short Form 36 (SF36) SF-36 is a multi-purpose health survey which yields an 8-scale profile of functional health and well-being scores as well as psychometrically-based physical and mental health summary measures.

The Clinical Disease Activity Index allows the assessment of actual disease activity, response to therapy, and achievement of particular states such as remission. The simplicity of the scoring system facilitates patient understanding of the level of their disease activity.

Related Stories

Recommended for you

Faulty gene linked to obesity in adults

August 18, 2017
Groundbreaking new research linking obesity and metabolic dysfunction to a problem in the energy generators in cells has been published by researchers from the Harry Perkins Institute of Medical Research and The University ...

Two lung diseases killed 3.6 million in 2015: study

August 17, 2017
The two most common chronic lung diseases claimed 3.6 million lives worldwide in 2015, according to a tally published Thursday in The Lancet Respiratory Medicine.

New test differentiates between Lyme disease, similar illness

August 16, 2017
Lyme disease is the most commonly reported vector-borne illness in the United States. But it can be confused with similar conditions, including Southern Tick-Associated Rash Illness. A team of researchers led by Colorado ...

Addressing superbug resistance with phage therapy

August 16, 2017
International research involving a Monash biologist shows that bacteriophage therapy – a process whereby bacterial viruses attack and destroy specific strains of bacteria - can be used successfully to treat systemic, multidrug ...

Can previous exposure to west Nile alter the course of Zika?

August 15, 2017
West Nile virus is no stranger to the U.S.-Mexico border; thousands of people in the region have contracted the mosquito-borne virus in the past. But could this previous exposure affect how intensely Zika sickens someone ...

Compounds in desert creosote bush could treat giardia and 'brain-eating' amoeba infections

August 15, 2017
Researchers at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego and the University of Colorado Anschutz Medical Campus have found that compounds produced by the creosote bush, a ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.