Disease activity in patients with rheumatoid arthritis has consistently improved since 2009, with remission rates increasing year on year, OPAL data suggest.
Researchers from OPAL (Optimising Patient outcomes in Australian rheumatoLogy) say the positive findings could translate into fewer hospital admissions and a reduced disease burden among the Australian population.
They tracked 48,388 patients (median age 60, 73% female) with rheumatoid arthritis (RA) from when OPAL data collection began in 2009 until 2022, using the Disease Activity Score 28-joint count C-reactive protein (DAS28CRP) definition of remission.
Writing in Clinical Rheumatology [link here], the researchers from OPAL Rheumatology and rheumatology clinics across multiple states, said the proportion of patients treated with biological or targeted synthetic (b/ts) DMARD therapy increased from 15% in 2009 to 45% in 2022.
Concurrently, the percentage of patients using conventional synthetic disease-modifying antirheumatic drugs (cs)DMARD therapy decreased from 54% to 39%.
The median number of annual visits for patients managed on csDMARD therapy was two per year, versus three visits for patients treated with b/tsDMARD therapy.
About half of patients in both groups were also treated with corticosteroids, which remained relatively stable over the duration of the study, the researchers noted.
Findings also showed a consistent and substantial improvement in DAS28CRP remission rates in all patients, patients managed on csDMARD and patients treated with b/tsDMARD therapy, rising from just under 50% in 2009 to over 70% by 2022.
The increase in DAS28CRP remission was accompanied by reduced proportions of patients in moderate disease activity (from 28% to 13%) and high disease activity states (from 7.5% to 3.5%).
The median DAS28CRP score for all groups was 2.6 in 2009 and 1.9 in 2022.
In other findings, a decreasing trend in time from symptom onset to first specialist appointment was identified, from longer than 50 months prior to 2011 to about 20 months from 2020 onwards, indicating improvements in seeking and receiving care.
“These trends collectively suggest earlier access to rheumatological expertise, facilitating swifter diagnoses and aligning with the availability of newer b/tsDMARDs over time, as factors contributing to more effective therapeutic management of the disease,” wrote the authors.
“The percentage of patients receiving no DMARD at the time of each data cut fell from 30% to 17% over the study period. These patients are not well characterised in this study but likely represent patients managed only on low-dose steroids or with otherwise mild or no disease activity at the time of assessment.”
No differences in remission rates were observed between the anti-cyclic citrullinated peptide (CCP) and/or rheumatoid factor (RF)-positive patients compared to CCP/RF-negative patients, nor any association between sex and likelihood of remission.