Moderate or High Rheumatoid Arthritis Disease Activity Carries Same Joint Failure Risk

Either patient group in need of more intensive treatment to reduce surgery risk.

Rheumatoid arthritis (RA) patients with moderate or high disease activity have a similar risk of joint failure that requires surgery, according to a recent study.

Some RA treatment guidelines call for additional therapy with a biological DMARD based on cut-off for disease activity, which excludes patients with moderate disease activity. The current study indicates both patient groups may require more intensive treatment to reduce the risk of undergoing joint surgery.

"It is well-established that sustained high disease activity in RA results in worse outcomes," lead author Elena Nikiphorou, MD, said in a press release. "In reality, however, many treated RA patients remain in low or moderate disease activity states and their outcomes, especially in the long term, are less well studied.”

The study utilized orthopedic surgery as a surrogate marker of joint destruction and failure in patients who experienced varying disease activity levels over the first 5 years from disease onset. Joint interventions were categorized as major, which included mainly large joint replacements; intermediate which included synovectomies, joint fusions and excision arthroplasties of the wrist, hand, or foot; or minor, which primarily included soft tissue surgery.

The study included 2071 patients, of which 2044 had at least 2 drug activity states (DAS) that were recorded between years 1 to 5. Of these patients, 21% were in remission, 15% had low DAS, 26% had low to moderate DAS, 21% had high to moderate DAS, and 18% had high DAS.

The disease activity was analyzed by calculating the mean DAS28 score for each patient after onset through year 5.

The results showed that low to moderate DAS, high to moderate DAS, and high DAS were all predictive of a greater risk for major joint surgery. Furthermore, high to moderate DAS and high DAS predicted a greater joint failure risk than low to moderate DAS or low DAS.

“Our data provide an argument for updating existing disease activity cut-off points to allow RA patients with moderate disease activity to receive a biological agent in addition to conventional DMARDs,” Dr. Nikiphorou said.