AB0223 Has the presentation and severity of rheumatoid arthritis changed in recent decades?

Abstract

Background: In recent decades, there have been social, economic and health changes, also in the treatment of rheumatoid arthritis (RA). The development and severity of RA can be affected by these changes. It is discussed if RA is currently less frequent and severe than before1. Objective(s): To determine the changes in the clinical and demographic variables and the severity of RA that may have occurred over a period of four decades (from 1980 to 2015) and its repercussion in the response to methotrexate (MTX) monotherapy. Method(s): We conducted a retrospective study, reviewing the records of patients from a cohort of RA who received MTX monotherapy and compared the results of demographic and clinical variables by natural decades. The statistical analysis was performed using the Chi2 test and the one-way ANOVA test. Result(s): We included 301 patients (202 women and 99 men) with a mean age at diagnosis of 49.6 (+/-13.2) years. The table 1 shows the characteristics of the complete sample and distributed by natural decades. The age at diagnosis was higher after 2000 (p<0.01), while the proportion of women, educational level, sedentary lifestyle, habits (tobacco, alcohol) and comorbidities did not change. There was also no variation in the joint pattern of presentation, percentage of RF/ACPA positive or mean value of RF and ACPA. There was a decrease in time from the onset of symptoms to diagnosis (from 21.7 to 15.3 months) (NS), but especially between the diagnosis and the first DMARD (from 34.5 to 1.4 months) and in the number of FAMEs before MTX (p<0.01 for both), as well as in the baseline activity of the disease (PCR and DAS28-PCR), early erosions (<2 years) and extra-articular involvement (p<0.01). There were no changes in the dose of prednisone and MTX, nor in the route of administration, while folic acid supplements increased. The suspension rate due to toxicity decreased (p<0.05), while the clinical remission rate improved (p<0.01) Conclusion(s): In our cohort, the severity of RA has decreased during the last four decades, the time to start MTX has been reduced and better remission rates with MTX monotherapy have been achieved.