Functional disability remains a
significant problem for people
with rheumatoid arthritis, with the
prevalence remaining at least 15%
higher over time than in individuals without the disease.
In a retrospective, longitudinal,
population-based cohort study,
the prevalence of patient-reported
functional disability was 26% in
586 individuals with rheumatoid
arthritis and 11% in 531 without
the disease at baseline (P less than
.001), a discrepancy that persisted
over almost 20 years of follow-up.
“We found a higher prevalence
of functional disability in patients
with RA versus non-RA,” the presenting study investigator Dr. Elena
Myasoedova said at the Congress.
Dr. Myasoedova, who is a clinical fellow in rheumatology at the
Mayo Clinic in Rochester, USA,
added that the increase in prevalence over time was significantly
higher in subjects with RA than in
those without RA (P = .003), but
that there was no difference in the
pace of this increase with adjustment for the duration of RA disease (P = .51).
There was also no difference in
functional disability between the
two groups of patients by about
the 8th or 9th decade.
RA remains one of the most
common conditions associated
with functional disability, Dr. My-
asoedova said, with several risk
factors for physical impairment
identified, including being female,
of older age, smoking, and the use
of certain medications (glucocorti-
coids and antidepressants), as well
as sociodemographic factors.
A discrepancy between im-
proved RA disease control and
persistent impairment in physical
function has been noted in prior
studies, but there are few data on
how this might change over time.
Dr. Myasoedova and her associ-
ates investigated this by analysing
data from the Rochester Epidemi-
ology Project, which collects med-
ical data on individuals living in
Olmsted County, Minnesota, USA.
They identified two populations
of adults aged 18 and older: one
diagnosed with RA according to
1987 American College of Rheu-
matology criteria between 1999
and 2013 and one without RA but
who were of a similar age and sex
and enrolled in the project around
the same time.
As part of the project, partici-
pants completed an annual ques-
tionnaire asking about their health
and ability to perform six activ-
ities of daily living (ADL). These
include the ability to wash, dress,
feed, and toilet oneself without
assistance, as well as perform nor-
mal household chores and walk
unaided. Over the course of the
study, 7,466 questionnaires were
completed by the participants, and
functional disability was defined
as having difficulty with at least
one of these six ADLs, Dr.
At baseline, subjects with and
without RA were aged a mean of
55 and 56 years, respectively, and
70% in both groups were female.
Similar percentages were current
(about 15%), former (about 30%),
or never smokers (about 55%), and
about 40% were obese.
Just under two-thirds (64.4%)
of patients in the RA cohort were
positive for rheumatoid factor (RF)
or anti–cyclic citrullinated peptide
(CCP) antibodies. While there was
a similar prevalence of functional
disability in RA patients who were
or were not RF or anti-CCP positive
(both 25%, P = .67), there was an
increasing prevalence in those who
were positive versus those who
were negative over time (P = .027).
Although the investigators did
not conduct an objective assess-
ment for functional disability, these
findings highlight the need for vig-
ilant management of patients with
RA, Dr. Myasoedova proposed.
“Early and aggressive treatment
regimens aimed at tight inflamma-
tion control can help prevent the dis-
abling effects of high disease activity
and joint damage, thereby lowering
functional disability,” she said in an
interview ahead of the Congress.
Future work, she observed,
should look at how the pattern of
functional disability changes and
the use of transition modeling to
understand the bidirectional pat-
tern of potential change and accu-
mulation of functional disability in
RA. The investigators also plan to
look at risk factors for persistent
and worsening functional disabil-
ity and how treatment – including
treat to target and biologics –
might affect this.
The U.S. National Institute of
Arthritis and Musculoskeletal and
Skin Diseases supported the study.
Dr. Myasoedova had no conflicts of
Dr. Elena Myasoedova
Functional disability prevails despite
rheumatoid arthritis treatment
BY SARA FREEMAN