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The consequences of rheumatoid arthritis: Quality of life measures in the individual patient

L. Pollard, E.H. Choy, D.L. Scott

L. Pollard, BSc, MRCP; E.H. Choy, MD, FRCP; D.L. Scott, BSc, MD, FRCP. Department of Rheumatology, GKT School of Medicine, Weston Education Centre, Kings College, London; Department of Rheumatology, Kings College Hospital, London, UK.

ABSTRACT
Despite conventional treatment, RA still has many deleterious consequences. From the patients' perspective, these include persistent pain, functional disability, fatigue, and depression modified by health beliefs and underlying psychological problems. Disability is a consequence of pain, active synovitis and joint damage. It is usually assessed by self-reported questionnaire; the Health Assessment Questionnaire (HAQ) remains the dominant disability measure, although generic health measures such as Short Form-36 and Nottingham Health Profile provide similar information.
Treatment with disease modifying drugs and biologic agents improves pain, fatigue and disability. We specifically evaluated the effects of both these drugs and also disease duration on disability assessed by HAQ scores, as there is most information on this topic and it is of fundamental importance to patients. In early RA HAQ gives a 'J-shaped' curve; the initial fall is due to the immediate benefits of treatment and the subsequent gradual rise due to the inability of therapy to fully suppress the disease or prevent progressive joint damage. In established RA HAQ scores increase by about 1% annually and over 25 years average HAQ scores increase by 1.0. Disease modifying drugs and biologics both significantly reduce HAQ scores and the reduction is maintained for 2-5 years. This reduction is seen in both early and established disease. Early steroid therapy has immediate symptomatic treatment, but does not have long-term benefits. Over 5 years the impact of aggressive therapy with disease modifying drugs declines and there is evidence that insufficient treatment is given to many patients with RA.
The outcome of RA is greatly improved by current treatment with disease modifying drugs and biologic agents. However, more needs to be done and achieving better results is enhanced by routinely measuring the impact of the disease in routine practice.

Key words
Rheumatoid arthritis; pain; fatigue, depression, disability, health assessment questionnaire.

Grant Support - We are grateful to the ARC (http://www.arc.org.uk) for supporting the programme of research in our unit. We would also like to acknowledge support to Kings College Hospital from the UK National Health Service (NHS) Research and Development Programme.
Please address correspondence to: Dr L. Pollard, Department of Rheumatology, GKT School of Medicine, Weston Education Centre, Kings College, Cutcombe Road, London SE5, UK.
E-mail: louise.pollard@kcl.ac.uk