Observational studyBMC musculoskeletal disorders2016
Changing clinical patterns in rheumatoid arthritis management over two decades: sequential observational studies.
Observational study in BMC musculoskeletal disorders, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- Targeted literature review of current treatments and unmet need in moderate rheumatoid arthritis in the United Kingdom.Rheumatology (Oxford, England) · 2021Pooled it
- Trial
- The clinical effectiveness of intensive management in moderate established rheumatoid arthritis: The titrate trial.Seminars in arthritis and rheumatism · 2020Trial
- Changing Patterns of Hospitalisation and Orthopaedic Procedure Profiles in Major Inflammatory Rheumatic Diseases in Germany: a Nationwide Analysis of Hospital Discharge Data.Rheumatology international · 2026Article
- Management and treatment outcomes of rheumatoid arthritis in the era of biologic and targeted synthetic therapies: evaluation of 10-year data from the KURAMA cohort.Arthritis research & therapy · 2024Article
- Utilizing biologic disease-modifying anti-rheumatic treatment sequences to subphenotype rheumatoid arthritis.Arthritis research & therapy · 2023Article
- Clinical conditions needed to acquire sustained functional remission in rheumatoid arthritis patients.Clinical rheumatology · 2021Article
- Synthetic and External Controls in Clinical Trials - A Primer for Researchers.Clinical epidemiology · 2020Review
- Characterization of a Subset of Patients With Rheumatoid Arthritis for Whom Current Management Strategies are Inadequate.ACR open rheumatology · 2019Article
- Real world long-term impact of intensive treatment on disease activity, disability and health-related quality of life in rheumatoid arthritis.BMC rheumatology · 2019Article
- Rheumatoid arthritis: The benefits of early treatment after decades.Nature reviews. Rheumatology · 2017Article
- Developing new therapeutic approaches for rheumatoid arthritis: the continuing challenges of clinical assessments.F1000Research · 2016Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundRheumatoid arthritis (RA) treatment paradigms have shifted over the last two decades. There has been increasing emphasis on combination disease modifying anti-rheumatic drug (DMARD) therapy, newer biologic therapies have become available and there is a greater focus on achieving remission. We have evaluated the impact of treatment changes on disease activity scores for 28 joints (DAS28) and disability measured by the health assessment questionnaire scores (HAQ).
methodsFour cross-sectional surveys between 1996 and 2014 in two adjacent secondary care rheumatology departments in London evaluated changes in drug therapy, DAS28 and its component parts and HAQ scores (in three surveys). Descriptive statistics used means and standard deviations (SD) or medians and interquartile ranges (IQR) to summarise changes. Spearman's correlations assessed relationships between assessments.
results1324 patients were studied. Gender ratios, age and mean disease duration were similar across all cohorts. There were temporal increases in the use of any DMARDs (rising from 61% to 87% of patients from 1996-2014), combination DMARDs (1% to 41%) and biologic (0 to 32%). Mean DAS28 fell (5.2 to 3.7), active disease (DAS28 > 5.1) declined (50% to 18%) and DAS28 remission (DAS28 < 2.6) increased (8% to 28%). In contrast HAQ scores were unchanged (1.30 to 1.32) and correlations between DAS28 and HAQ weakened (Spearman's rho fell from 0.56 to 0.44).
conclusionsTreatment intensity has increased over time, disease activity has fallen and there are more remissions. However, these improvements in controlling synovitis have not resulted in comparable reductions in disability measured by HAQ. As a consequence the relationship between DAS28 and HAQ has become weaker over time. Although the reasons for this divergence between disease activity and disability are uncertain, focussing treatment entirely in suppressing synovitis may be insufficient.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.