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Reduced Burden of Disease and Improved Outcome of Patients with Rheumatoid Factor Positive Rheumatoid Arthritis Compared with Dropouts. A 10 Year Observational Study
JOHN DARMAWAN, JOHANNES J. RASKER, and HENDRI NURALIM
ABSTRACT.
Our objective was to determine outcome and burden of disease in a 10 year study of patients with rheumatoid factor positive rheumatoid arthritis (RF+ RA) compared with study dropouts. Three hundred and one consecutive subjects with disease duration of 3–255 months at presentation were enrolled. The acute (as measured by C-reactive protein, CRP) and chronic (by erythrocyte sedimentation rate, ESR) phases of RF+ RA were suppressed by pulse intravenous (IV) combination of low dose methylprednisolone (MPS) + cyclophosphamide (CYC) for 3 consecutive days and weekly intravenous methotrexate (MTX) with simultaneous oral cyclosporine (CSA) + mycophenolate mofetil (MPM). After achieving negative CRP and ESR < 40 mm/h, IV therapy was tapered and switched to oral low dose MTX+CSA+MPM until negative CRP titer and ESR < 25 mm/h (men < 15 mm) Westergren were achieved. American Rheumatism Association (ARA) functional classification measured disability. Dropouts did not complete the study for various reasons. At baseline, cases and dropouts were comparable in age and sex distribution, including mean age, disease duration, disease features, and associated conditions. Mortality in 274 cases was 2.9% versus 25.9% in dropouts. ARA functional class in cases decreased from 3.2 ± 0.7 to 1.4 ± 0.3 and in dropouts was 3.2 ± 0.6 at baseline versus 3.5 ± 0.5 at outcome. Disability of dropouts was significantly worse compared with cases. In dropouts, more associated conditions occurred than in cases. The burden of disease and outcomes were significantly worse in dropouts compared with cases. (J Rheumatol 2003;30 Suppl 67:50-53)
Key Indexing Terms:
RHEUMATOID FACTOR POSITIVE
RHEUMATOID ARTHRITIS
IMMUNOSUPPRESSANT
MORTALITY
OUTCOME
BURDEN OF DISEASE
From the WHO Collaborating Center, Community-Based Epidemiology, Prevention, and Treatment of Rheumatic Disease, Seroja Rheumatic Center, Semarang, Indonesia; and Department of Rheumatology, Medisch Spectrum Twente and Communication Studies, University Twente, Enschede, The Netherlands.
J. Darmawan, MD, PhD, Director; H. Nuralim, MD, WHO Collaborating Center, Community-Based Epidemiology, Prevention, and Treatment of Rheumatic Disease, Seroja Rheumatic Center; J.J. Rasker, MD, Department of Rheumatology, Medisch Spectrum Twente and Communication Studies, University Twente.
Address reprint requests to Dr. J. Darmawan, Seroja Rheumatic Center, Jalan Seroja Dalam 7, Semarang 50136, Indonesia.
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