RA Linked to Higher Health Burden, Lower HRQoL in Pre-RA

Barbara Torlinska, PhD, MSc

Credit: Visible Analytics

Patient-reported outcomes were associated with disease activity levels and sociodemographic characteristics among a cohort of patients with rheumatoid arthritis (RA), clinically suspect arthralgia (CSA), and unclassified arthritis (UA), according to a study published in BMC Musculoskeletal Diseases.¹

Patients with RA self-reported a higher health burden compared with those with UA or CSA. Additionally, the health-related quality of life (HRQoL) in patients with pre-RA was significantly lower compared with the general population.

As early treatment of RA improves key clinical outcomes, including joint damage and disease activity, it is important to identify patients “at-risk” for developing classifiable RA.²

“Subjective perceptions of health status can be captured via patient-reported outcome measures (PROMs), which can quantify symptoms, functional ability and general health status,” wrote a group of investigators led by Barbara Torlinska, PhD, MSc, associated with the Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research at the University of Birmingham in the United Kingdom. “The impact of RA on PROMs is well understood, and PROMs are included in the core set of measures for RA clinical trials. However, the extent to which PROMs are impacted in pre-RA phases is less clear.”

To evaluate the HRQoL, fatigue, depression, and function among newly presenting patients with RA, CSA, and UA, a cross-sectional analysis of baseline PROMs was performed using patients from the Birmingham Early Arthritis Cohort. These measures were assessed using the Patient Health Questionnaire (PHQ)-9, the EuroQol 5 Dimension (EQ-5D), and the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F). PROMs were compared among these patient populations as well as among population averages from the Health Survey for England (HSE). Associations between clinical and sociodemographic variables and patient-reported outcomes were determined using multivariate linear regression.

Among a total of 838 patients included in the study, 484 had RA, 200 had CSA, and 154 had UA.

Patients with RA self-reported worse outcomes for all PROMs compared with CSA or UA. However, the mean EQ-5D utilities were slightly higher in CSA (.65; 95% confidence interval [CI]: .61 — .69) and UA (.61; 95% CI .56 — .66) compared with RA (.47; 95% CI .44 — .50). These results were lower than the general population and among older (≥ 65 years) participants.

For those with CSA and UA, HRQoL was comparable to other chronic conditions such as mild angina, severe chronic obstructive pulmonary disease (COPD), or heart failure. Patients with a higher body mass index (BMI) or older age (≥ 60 years) were more likely to have worse depression (PHQ-9: -2.47 [-3.85 — -1.09], P <.001) and fatigue (FACIT-F: 5.05 [2.37 — 7.73], P <.001). Female patients were more likely to report worse function (HAQ-DI: .13 [.03 — .21], P = .01) and fatigue (FACIT-F: -3.64 [-5.59 — -1.70], P <.001) compared with males. Further, people living in more deprived areas had decreased function (HAQ-DI: .23 [.10 — .36], P = .001), worse depression (PHQ-9: 1.89 [.59 — 3.18], P = .004), and fatigue (FACIT-F: -2.60 [-5.11 — 0.09], P = .04).

After investigators adjusted for confounding factors, disease activity and polypharmacy were linked to poorer performance across all PROMs. However, the diagnostic category was not associated with PROMs.

Investigators mentioned the recruitment of CSA patients based on clinical opinion as a limitation of the study. Additionally, the cross-sectional study design left them unable to assess a potential relationship between patient-reported burden at baseline to disease status at follow-up. 

“Our study shows that decreased functional status and compromised health outcomes are reported in individuals at risk of RA,” investigators concluded. “Studies of pharmacological intervention in the at-risk stages should therefore assess the impact of the intervention on these important patient-reported outcomes.”

References

1. ^{Torlinska B, Raza K, Filer A, et al. Predictors of quality of life, functional status, depression and fatigue in early arthritis: comparison between clinically suspect arthralgia, unclassified arthritis and rheumatoid arthritis. BMC Musculoskelet Disord. 2024;25(1):307. Published 2024 Apr 20. doi:10.1186/s12891-024-07446-6}
2. ^{Gerlag DM, Raza K, van Baarsen LGM, Brouwer E, Buckley CD, Burmester GR, et al. EULAR recommendations for terminology and research in individuals at risk of rheumatoid arthritis: report from the Study Group for Risk factors for rheumatoid arthritis. Ann Rheum Dis. 2012;71(5):638–41.}