Strategies for optimal suppression of rheumatoid arthritis Kooij, S.M. van der

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Strategies for optimal suppression of rheumatoid arthritis

Kooij, S.M. van der

Citation

Kooij, S. M. van der. (2009, January 22). Strategies for optimal suppression of rheumatoid arthritis. Retrieved from https://hdl.handle.net/1887/13425

Version: Corrected Publisher’s Version

License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the

University of Leiden

Downloaded from: https://hdl.handle.net/1887/13425

Note: To cite this publication please use the final published version (if

applicable).

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Table 1. Baseline patient demographics and disease characteristics.

Group 1 Sequential monotherapy

N=126

Group 2 Step-up combination

therapy N=121

Group 3 Initial com-

bination + prednisone

N=133

Group 4 Initial com-

bination + inﬂiximab

N=128

Sex (female), no. (%) 85 (68) 87 (72) 88 (66) 83 (65)

Age (years) 54.4 (13.1) 54.4 (13.5) 54.6 (14.1) 54.3 (14.3)

Symptom duration (weeks), median (IQR) 23 (14-54) 26 (14-56) 23 (15-52) 23 (13-46)

IgM RF positive, no. (%) 84 (67) 77 (64) 86 (65) 82 (64)

Erosions on baseline radiograph, no (%) 89 (72) 82 (70) 93 (71) 93 (73)

DAS 4.54 (0.9) 4.47 (0.8) 4.37 (0.9) 4.31 (0.9)

HAQ (0-3) 1.41 (0.7) 1.39 (0.6) 1.42 (0.7) 1.38 (0.7)

IQR = interquartile range; RF = rheumatoid factor; DAS = disease activity score (44 joint count); HAQ = health assessment questionnaire. Data are presented as the mean (SD) unless indicated otherwise. P>0.05 for all baseline comparisons.

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Figure 1. Percentage of patients reporting less difﬁculty with priority-ranked impaired activities of the MACTAR compared with baseline.

A. Housework, N=257; P0.001 for groups 1 and 2 versus groups 3 and 4 at 3 months; P0.05 for group 1 versus groups 3 and 4 at 6 months;

P0.05 for group 4 versus groups 1 and 2 at 9 months. B. Paid work, N=106; P0.05 for group 1 versus groups 3 and 4 at 12 months. C. Sleep- ing, N=224; P0.05 for group 1 versus group 3 at 3 months.

A. housework

0 3 6 9 12

0 20 40 60 80 100

time (months)

% less difficulty

group 1 group 2 group 3 group 4

% less difficulty

B. paid work

0 3 6 9 12

0 20 40 60 80 100

time (months)

% less difficulty

C. sleeping

0 3 6 9 12

0 20 40 60 80 100

time (months)

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Table 2. Improvement throughout 2 years in functional ability (MACTAR), health related quality of life (physical and mental component summary scales of the SF-36), and VAS measurements for pain, disease activity and global health. Data are presented as the mean change from baseline except for the baseline value.

Group 1 Group 2 Group 3 Group 4 p-value MACTAR

Baseline 47.5 47.1 47.3 47.0 0.77

3 months 10.6 9.5 16.7 17.3 <0.001^†

6 months 12.6 15.4 16.4 19.1 <0.001^‡

1 year 15.2 16.3 16.9 19.3 0.02^§

SF-36 Physical Component Summary

Baseline 32.9 32.9 32.8 33.4 0.93

3 months 5.8 3.9 11.2 9.6 <0.001^†

6 months 8.0 8.5 12.5 12.4 <0.001^†

1 year 8.9 11.2 11.9 12.0 0.10

2 years 11.9 12.3 12.3 12.7 0.95

SF-36 Mental Component Summary

Baseline 47.5 46.3 47.6 47.6 0.73

3 months 2.1 2.5 0.4 3.1 0.22

6 months 3.1 3.5 1.2 4.1 0.17

1 year 4.3 4.4 3.2 4.3 0.83

2 years 4.3 4.6 4.6 4.0 0.97

VAS pain

Baseline (0-100) 53.1 53.4 54.1 54.1 0.98

3 months -15.1 -13.4 -29.2 -26.6 <0.001^†

6 months -17.4 -25.5 -30.3 -30.2 <0.001^¶

1 year -21.3 -26.0 -28.9 -30.5 0.05^§

2 years -28.2 -27.3 -26.9 -32.6 0.33

VAS disease activity

Baseline (0-100) 59.2 59.4 59.5 61.8 0.77

3 months -18.7 -18.2 -35.9 -34.2 <0.001^†

6 months -22.3 -28.0 -32.0 -35.9 0.003^¶

1 year -27.5 -29.8 -32.8 -38.3 0.03^§

2 years -33.2 -33.0 -31.5 -39.0 0.19

VAS global health

Baseline (0-100) 51.9 51.9 50.6 55.0 0.36

3 months -16.8 -11.8 -22.0 -28.9 <0.001^#

6 months -17.7 -21.3 -21.5 -28.4 0.01^§

1 year -21.7 -23.2 -22.7 -30.0 0.06

2 years -26.4 -25.6 -23.9 -31.8 0.10

MACTAR = McMaster Toronto Arthritis Patient Preference Disability Questionnaire; SF-36 = Short Form-36;

VAS = Visual Analogue Scale. † P<0.05: groups 1 and 2 versus groups 3 and 4; ^‡ P<0.05: groups 1 and 2 versus group 4, and group 1 versus group 3; § P<0.05: group 1 versus group 4; ¶ P<0.05: group 1 versus groups 3 and 4; # P<0.05: groups 1 and 2 versus group 4, and group 2 versus group 3.

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A. physical functioning

0 3 6 9 12 15 18 21 24

20 40 60 80

100 group 1

group 2 group 3 group 4

time (months)

B. role physical

0 3 6 9 12 15 18 21 24

0 20 40 60 80

100 group 1

time (months)

C. bodily pain

0 3 6 9 12 15 18 21 24

20 40 60 80

100 group 1

time (months)

D. general health

0 3 6 9 12 15 18 21 24

20 40 60 80

100 group 1

time (months)

E. vitality

0 3 6 9 12 15 18 21 24

20 40 60 80 100

time (months)

F. social functioning

0 3 6 9 12 15 18 21 24

20 40 60 80 100

time (months)

G. role emotional

0 3 6 9 12 15 18 21 24

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time (months)

H. mental health

0 3 6 9 12 15 18 21 24

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100 group 1

time (months)

Figure 2. Changes over time in SF-36 subscales by linear mixed-effect models. The y-axes indicate the raw SF-36 subscale scores ranging from 0-100. The horizontal line in each graph represents the norm of an age- and sex-matched Dutch population (24).

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Table 3. Percentages of patients reporting limitations in physical and mental health-related quality of life:

content-based interpretations of 2-year changes in SF-36 scale scores.

SF-36 scale Selected dichotomized item Group 1 Group 2 Group 3 Group 4

BL 24 BL 24 BL 24 BL 24

Physical functioning

Any limitations in walking one block

56 30 62 29 62 25 50 23

Role-physical Cut down amount of time spent on work / activities

81 31 82 31 82 34 81 37

Bodily pain Pain interfered with work a lot or extremely

58 7 55 7 48 6 47 5

General health

Fair or poor rating of health in general

60 22 67 20 61 24 68 24

Vitality Tired all or most of the time 64 37 62 32 64 34 65 36 Social func-

tioning

Health interferes with social function a lot or extremely

23 11 23 9 23 6 25 6

Role-emotional

Did not do work / activities as carefully as usual

47 25 46 23 44 20 45 16

Mental health Downhearted and blue all or most of the time

16 7 19 8 16 5 20 6

SF-36 = Short Form-36; BL = baseline; 24 = 24 months.

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Strategies for optimal suppression of rheumatoid arthritis Kooij, S.M. van der