How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early RA Study (ERAS)

Objectives. To assess the impact of rheumatoid arthritis (RA) on function a nd how this affects major aspects of patients' lives. Methods. The inception cohort of RA patients was recruited from rheumatolog y out-patient departments in nine National Health Service (NHS) hospital tr usts in England. All consecutive patients with RA of less than 2 yr duratio n, prior to any second-line (disease modifying) drug treatment were recruit ed and followed-up for 5 yr. Standard clinical, laboratory and radiological assessments, and all hospital-based interventions were recorded prospectiv ely at presentation and yearly. The outcome measures were clinical remissio n and extra-articular features, Functional ability [functional grades I-IV and Health Assessment Questionnaire (HAQ)], use of aids, appliances and hom e adaptations, orthopaedic interventions, and loss of paid work. Results. A total of 732 patients completed 5 yr of follow-up, of whom 84% r eceived second-line drugs. Sixty-nine (9.4%) had marked functional loss at presentation, compared with normal function in 243 (33%), and by 5 yr these numbers had increased in each group, respectively, to 113 (16%) and 296 (4 0%). Home adaptations and/or wheelchair use by 5 yr were seen in 74 (10%). Work disability was seen in 27% of those in paid employment at onset. One h undred and seventeen (17%) patients underwent orthopaedic surgery for RA, 5 5 (8%) for major joint replacements. Marked functional loss at 5 yr was mor e likely in women [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.04- 2.5], patients older than 60 yr (OR 1.94, 95% CI 1.3-2.9), and with HAQ > 1 .0 at presentation (OR 4.4, 95% CI 2.8-7.0). Conclusions. Clinical profiles of RA patients treated with conventional dru g therapy over 5 yr showed that a small proportion of patients (around 16%) do badly functionally and in terms of life events, whereas around 40% do r elatively well. The details and exact figures of cumulative disability are likely to be useful to clinicians, health professionals and patients. The r ate of progression and outcome in these patients can be compared against fu ture therapies with any disease-modifying claims.