Outcome in rheumatoid arthritis patients with continued conventional therapy for moderate disease activity--the early RA network (ERAN). The influence of sex on rheumatoid arthritis: a prospective study of onset and outcome after 2 years.
OBJECTIVE To report from early RA network ( ERAN ) on Years 2 and 3 28-joint DAS ( DAS-28 ) and HAQ outcomes in newly diagnosed RA patients treated with DMARD therapies stratified to DAS-28 status after 1 year . METHODS ERAN is a prospect i ve observational cohort of newly diagnosed RA patients , monitored and treated according to local practice . St and ardized case report forms are completed at first presentation , 3 - 6 months , 1 year and annually thereafter . RESULTS A total of 418 newly diagnosed RA patients with 2 years and 302 with 3 years follow-up were identified in 22 ERAN centres from 2002 to 2008 . Within their first year from registration , 67 % of patients received monotherapy DMARDs , and 26 % combination DMARDs including 2 % were on anti-TNF therapies . Between Years 1 and 3 , 60 % received DMARD monotherapy , 34 % combination DMARD therapy including 8 % on anti-TNF therapies . Seventy-four per cent of patients with Year 1 DAS-28 < 3.2 and 27 % with DAS-28 3.2 - 5.1 achieved a DAS-28 < 3.2 outcome at Year 2 [ odds ratio ( OR ) 7.64 ; 95 % CI 4.6 , 12.6 ] , and 71 and 35 % , respectively , at Year 3 ( OR 4.49 ; 95 % CI 2.5 , 7.9 ) . Seventy-nine per cent of patients with a Year 1 DAS-28 < 3.2 and 52 % with DAS-28 3.2 - 5.1 achieved an HAQ < 1.25 at Year 2 ( OR 3.47 ; 95 % CI 2.1 , 5.6 ) , and 81 and 47 % , respectively , at Year 3 ( OR 4.92 ; 95 % CI 2.6 , 9.0 ) . CONCLUSIONS In RA patients with a DAS-28 3.2 - 5.1 at 1 year , the likelihood of achieving a target low DAS-28 < 3.2 , or a low HAQ , at Years 2 or 3 is poor in a routine care setting using conventional DMARDs according to current practice OBJECTIVE This prospect i ve study analyzed influence of patient 's sex on early rheumatoid arthritis ( RA ) within one year of disease onset and after 2 years ' followup . METHODS A total of 844 consecutive patients , 538 women , with RA of less than 12 months were studied . St and ardized clinical and radiographic assessment s were performed at study entry and after 2 years . The association of several variables at study entry with the outcome variables Disease Activity Score ( DAS28 ) , functional disability measured by the Health Assessment Question naire ( HAQ )  , and , in 390 patients ,  Larsen score  at the  2-year followup  were analyzed in men and women separately . RESULTS At study entry the women were younger compared with the men and the sexes showed different age distributions . The women had higher DAS28 and HAQ scores . However , women below 50 years of age at study entry had milder disease than older women and close to that of men . At 2-year followup the women still had higher DAS28 and HAQ scores compared to men , who had achieved remission in a higher frequency . Larsen score showed no sex difference either at study entry or after 2 years . Presence of rheumatoid factor ( RF ) was associated with lower age at study entry and higher DAS28 at followup in men only . Higher DAS28 and HAQ scores at entry were more strongly correlated with severe disease at followup in women than in men . Presence of the " shared epitope " was not associated with age or the outcome variables DAS28 and Larsen score in either sex . CONCLUSION The disease phenotype in early RA was significantly different between men and women , particularly concerning age , disease activity , and functional capacity . There were differences between the sexes concerning early disease characteristics associated with outcome at 2 years of followup
Objectives Access to biologic DMARDs for RA is often restricted to those with severe disease .
This systematic review aim ed to identify prognostic factors in patients with moderate disease activity who may be at risk of disease progression and poor clinical outcomes .