Physical Disability and Psychological Distress in RA Patients Reduced by 50% in Last 20 Years
Twenty years ago, half of newly diagnosed rheumatoid arthritis patients were physically disabled after the first four years of treatment and significant percentages of patients experienced high levels of depression and anxiety. In general, rheumatologists didn’t aggressively treat newly diagnosed patients and often recommended that patients limit physical activity to avoid exacerbating their disease. But times have changed.
Nowadays, only 1 out of 4 RA patients are disabled after the first four years of treatment and the percentages of patients with depressed mood and anxiety have been reduced about 50%, according to a new study published today in Arthritis Care & Research, a journal of the American College of Rheumatology (ACR). That’s good news for patients diagnosed today whose treatment choices, both pharmacological and non-pharmacological, have improved since 20 years ago.
Not only have attitudes toward evidence-based medicine changed in recent decades, but treatment options have increased dramatically. Rheumatologists are also more likely to recommend non-pharmacological treatments such as physical exercise to patients.
Twenty years ago, patient treatment options were limited to traditional DMARDs (disease-modifying anti-rheumatic drugs) such as methotrexate, sulfasalazine, or hydroxychloroquine. Since FDA approval of the first biologic therapy to treat RA in 1998, treatment options have expanded to include 9 biologic agents in addition to Xeljanz, which is first in a new class of treatments called Janus-associated kinase (JAK) inhibitors, and additional DMARDs such as Arava.
“Earlier diagnosis, more intensive interventions along with recommendations to live a full life and to be physically active may help improve daily living for those with RA,” explains lead author, Cécile L. Overman, a Ph.D. Candidate with the Department of Clinical and Health Psychology, Utrecht University in The Netherlands. “Our study examined if psychological distress and physical disability in RA patients reduced over the last two decades.”
For the present study, researchers in the Netherlands recruited 1151 with newly diagnosed RA between 1990 and 2011. Participants were 17 to 86 years of age with 68% being female. Each participant was assessed at the time of diagnosis and monitored for the following three to five years.
At time of diagnosis, the average percentage of patients with depressed mood, anxiety, or physical disability declined from 43%, 34%, and 64%, respectively, in 1990-1994 to 32%, 21%, and 60% in 2004-2008. At patient follow-up (after the first four years of treatment), these percentages had dropped to 25%, 23%, and 53% in 1994-1998 and 14%, 12%, and 31% in 2007-2011. The decrease in physical disability remained significant even after adjusting for reduced disease activity.
Researchers suggest that the downward trend in physical disability, anxiety, and depressed mood may be due in part to reduced disease activity. However, earlier diagnosis, more emphasis on enhanced physical activity, and encouragement to patients to live a “valued life” may also be contributing factors.
The decrease of psychological distress over the decades was not as pronounced as the decrease of physical disability. Study authors emphasize, however, that even small improvements in mood and anxiety across the decades is remarkable when considering that psychological distress increased in the general population rather than decreased during the same time period.
Years ago, it seemed that RA patients would certainly experience crippling disability and be unable to participate in desired activities. From what I’ve read, this was simply to be expected. However, that outlook has changed and today patients expect to be able to stay active and fight against disability, pain, and deformity through the use of targeted treatments.
“Today, RA patients have a better opportunity of living a valued life than patients diagnosed with this autoimmune disease two decades ago,” concludes Ms. Overman.
Overman CL, Jurgens MS, Bossema ER, et al. Patients with rheumatoid arthritis nowadays are less psychologically distressed and physically disabled than patients two decades ago. Arthritis Care & Research. Published Online December 3, 2013. doi: 10.1002/acr.22211