Rheumatoid Arthritis – Now & Then
Dr C Donaghy, Dr K Patterson, Dr A Pendleton
Musgrave Park Hospital, Belfast HSCT
There have been significant changes in the investigation and treatment of rheumatoid arthritis over the past number of decades. Disease is now detected earlier, and there is a wider range of DMARD and biological drug treatments available.
We compared two cohorts of patients with RA to examine characteristics including demographics, extraarticular manifestations, drug treatments used, and joint injections and replacements.
We reviewed charts of patients with RA who had been inpatients through the 1970’s-1990’s, diagnosed prior to 1990 (Group 1), and compared with patients diagnosed post 2000, who were coded as seropositive RA (Group 2). We examined 50 charts for each group.
Demographics were similar, with 78% and 82% female, and peak age at diagnosis being between 46 - 60. There were a higher proportion of patients diagnosed with late onset RA in Group 2. Group 1 included patients with multiple admissions. The most common reason for admission was flare of disease. Group 2 did not include any inpatient admissions. There is a substantial reduction in extra-articular manifestations, with radiographic erosions of 70% and 18%, cardiac involvement of 50% and 2%, anaemia of 50% and 18%, cutaneous nodules of 36% and 2%, lung disease of 24% and 2%, osteoporosis of 24% and 12%, vasculitis of 10% and 0%, and eye disease of 8% and 0% respectively. Use of DMARDS included distamine in 62% and 0%, sulfasalazine in 50% and 50%, gold in 44% and 2%, long term steroids in 40% and 18%, methotrexate in 14% and 92%, hydroxychloroquine in 14% and 50%, and leflunomide in 0% and 36% respectively. Group 2 also included several patients on biologic agents. A much higher side effect profile was noted with the broader range and higher doses of DMARDs. Group 2 demonstrated a lower number of joint injections being carried out overall but a higher proportion of small joints being injected. Joint replacements are also much reduced, with hip and knee remaining the most commonly implicated joints.
The study has shown that as treatments for RA have evolved, there is a much lower rate of inpatient hospital admissions, extra-articular manifestations and surgical treatments.