MEASURES OF ACTIVITY AND DAMAGE IN RHEUMATOID-ARTHRITIS - DEPICTION OF CHANGES AND PREDICTION OF MORTALITY OVER 5 YEARS

Objective. To analyze various quantitative measures of inflammatory ac tivity and joint damage, including articular, radiographic, laboratory questionnaire, and physical function measures, in regard to changes i n status in surviving patients and prediction of mortality in non-surv ivors over 5 years in a cohort of patients with rheumatoid arthritis ( RA) monitored in the mid-1980s and early 1990s. Methods. A comprehensi ve evaluation, which included a complete joint count, radiograph, labo ratory tests, physical measures of function, and self-report questionn aire scales, was performed at baseline and 5 years later in 210 consec utive patients with RA. Results. Five years after baseline, 206 of the 210 patients were accounted for 37 had died, 130 had a comprehensive repeat assessment, and 39 had a more limited repeat assessment. In sur viving patients, most measures of activity were generally unchanged or somewhat better, including joint tenderness, pain on motion, and swel ling; erythrocyte sedimentation rate and rheumatoid factor; as well as questionnaire scores for pain, global status, helplessness, and diffi culty in performing 8 activities of daily living (ADL) according to a modified Health Assessment Questionnaire (MHAQ). By contrast, measures of damage, including joint deformity, grip strength, walk time, and r adiographic scores, indicated worse status. Mortality over 5 years was predicted significantly in univariable analyses by American College o f Rheumatology (formerly the American Rheumatism Association) Function al Class, limited joint motion, scores for MHAQ, global status, helple ssness, grip strength, walk time, button time, and number of comorbidi ties and duration of diseases, as well as the sociodemographic measure s of age and formal education. In multivariable Cox regressions, age, comorbidities, MHAQ, and other measures of functional status were the most effective predictors of 5-year mortality. Conclusion. In patients with RA, most measures of inflammatory activity were unchanged and so metimes better, while measures of damage indicated worse status in the same patients over 5 years. Measures indicating functional disability , as well as age and comorbidities, predict 5-year mortality more effe ctively than radiographic and laboratory data. Measures of inflammator y activity may underestimate long-term outcomes in RA, and long-term s tudies should include measures of damage.