Physical and mental disability is evident 8 years after diagnosis in early rheumatoid arthritis despite contemporary medication and non-pharmacological interventions.

Abstract

Introduction: Early interventions are known to reduce disease activity and physical disability in rheumatoid arthritis (RA), but less is known about mental health, especially in the era of early active pharmacotherapy. Consequently, we compared long-term physical and mental disability in an early RA cohort (1996-1998) with a later cohort (2006-2008).

Methods: We compared 320 patients from our project Early Intervention in RA (1996-1998) (TIRA-1) with 463 patients from TIRA-2 (2006-2008). During the 8-year follow-up, pharmacotherapy and multi-professional interventions were offered according to guidelines. Disease Activity Score (DAS28), prescribed disease-modifying antirheumatic drugs (DMARDs), Health Assessment Questionnaire (HAQ), and Short Form Health Survey (SF-36) were registered yearly.

Results: Significantly more patients were prescribed DMARDs in TIRA-2 than in TIRA-1, and initial improvements were seen for DAS28 and disability in both cohorts. At follow-up, TIRA-2 patients reported less physical disability (HAQ) and less mental disability (SF-36) than TIRA-1 patients. Despite improvements, 32% of the women and 21% of the men in the TIRA-2 cohort reported considerable disability (HAQ ≥ 1) at the 8-year follow-up.

Conclusions: Despite improvements in our contemporarily treated TIRA-2 cohort, physical and mental disability was evident 8 years after diagnosis, especially among women. These results suggest a forthcoming need for person-centered non-pharmacological rehabilitation programs to optimize physical and mental function and to improve participation in daily life in RA. Also, the results highlight the need for developing new interventions directed at reducing disability. Key Points • Physical and mental disability is still considerable in contemporarily treated RA. • Interventions specifically aimed to reduce these disabilities need to be further developed. • Patients with severe disability need to be identified in clinical settings and offered person-centered rehabilitation.