Twenty-year outcome and association between early treatment and mortality and disability in an inception cohort of patients with rheumatoid arthritis: Results from the Norfolk Arthritis Register

James M Gwinnutt, Deborah Pm Symmons, Alexander J MacGregor, Jacqueline R Chipping, Tarnya Marshall, Mark Lunt, Suzanne Mm Verstappen

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Objective – To describe the outcome of patients with rheumatoid arthritis (RA) over 20 years from symptom onset; to assess the association between early treatment (DMARDs/steroids) and mortality and disability over follow-up. Methods – Patients from the Norfolk Arthritis Register recruited from 1990-94 who met the 2010 ACR/EULAR RA criteria at baseline were included in this analysis. Demographic/clinical variables were collected at baseline and years 1-3, 5, 7, 10, 15 and 20. Disease activity (swollen/tender joint counts (SJC/TJC)), disability (HAQ) and mortality over 20 years are described. Association between treatment group (early treatment (ET) = treatment ≤6 months after symptom onset; late treatment (LT) = treatment >6 months; never treatment (NT) = no treatment) and mortality and disability were assessed using weighted pooled logistic regression and weighted multilevel mixed-effects linear regression respectively. Inverse weights were used to account for indication/censoring confounding. Results – This study included 602 patients with RA (median (IQR) age = 56 (44, 68) years; 65.9% women). Median disease activity was low over follow-up (SJC 1-3, TJC 3-6). Median HAQ rose after year 1 but remained at low/moderate levels (median 1.25 after year 10). There was reduced mortality risk in the ET and LT compared to NT group. ET group had comparable HAQ to NT group over follow-up (β 0.03, 95% CI -0.06, 0.12); LT group had increased disability (LT vs NT β 0.10, 95% CI 0.02, 0.17). Conclusion – This study indicates the importance of early treatment regarding long-term outcomes of patients with RA. This article is protected by copyright. All rights reserved.
Original languageEnglish
Pages (from-to)1566–1575
JournalArthritis & Rheumatology
Issue number8
Early online date20 Apr 2017
Publication statusPublished - Aug 2017


  • Early Rheumatoid Arthritis
  • Outcomes research
  • DMARDs
  • Epidemiology
  • Arthritis Research UK Centre of Excellence in Epidemiology

    Macgregor, A., Symmons, D., Abrahamowicz, M., Arden, N., Ashcroft, D., Bruce, I., Buchan, I., Cooper, C., Dixon, W., Emsley, R., Farewell, V., Felson, D., Hyrich, K., Lunt, M., Macfarlane, G., McBeth, J., NNUH, T., O'Neill, T., Oldham, J., Pan, J., Payne, K., Rothman, K., Sturmer, T., Thomson, W., Tobias, J., Urowitz, M., Windt, D. & Wu, F.

    Versus Arthritis


    Project: Research

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