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Background In patients with rheumatoid arthritis (RA) increased mortality, especially for cardiovascular (CV) events, is still described, despite the advances in RA management. Objectives To evaluate the impact of early diagnosis and treatment with disease modifying anti-rheumatic drugs (DMARDs) on mortality in patients with early RA and undifferentiated arthritis (UA) through record linkage between clinical and administrative databases. Methods Consecutive patients with RA or UA from an early arthritis clinic (2005–2016), treated with tight control to achieve DAS28 6 months), from diagnosis to treatment ( 3 months, never) and from onset to treatment ( 6 months, never) on overall mortality. Analyses were adjusted for age, gender, ACPA positivity, Charlson comorbidity index, HAQ and median daily prednisone dose. Results were presented as hazard ratios (HR) with 95% CI. Secondary analyses categorising prednisone in low dose (≤5 mg/day) or medium-high dose (>5 mg/day) were performed, as well as analyses evaluating CV mortality as outcome. Moreover, analyses excluding patients not receiving DMARDs and patients dying in the first year of observation were conducted. Results A total of 857 patients (62% RA, 73% female, median (IQR) age 59,47–71 mean (sd) baseline DAS28 3.08 (0.97)) were included. After a median (IQR) follow-up of 8051–109 months, 77 patients died (2 in the first year); of the 41 patients with known cause of death, 9 were for CV causes. An interval >3 months between diagnosis and introduction of DMARDs or never introducing DMARDs related to higher mortality (table 1). The mean daily prednisone dose was not a significant predictor of mortality, while in all secondary analyses patients receiving low-dose prednisone, compared to those never receiving corticosteroids, had a lower mortality (eg. HR (95% CI) 0.45 (0.26,0.78) in the model including time between symptom onset and diagnosis). Patients not starting DMARDs, compared to these starting within 3 months from diagnosis, had a higher CV mortality), while the intervals between onset and diagnosis and onset and treatment were not significant predictors. Analyses limited to patients receiving DMARDs and with the exclusion of patients dying in the first year yielded to similar results. Conclusions In patients with early RA and UA treatment delay significantly increases mortality, while low-dose corticosteroids seem to decrease mortality. These result support strategies aiming at early access to treatment and the use of low dose corticosteroids in the initial treatment strategy. Disclosure of Interest None declared |
