Structured and prompt treatment of early arthritis in clinical practice leverages window of opportunity and leads to excellent clinical outcomes: an innovative retrospective cohort study

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2024年10月29日

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R. L. Teixeira,
R. da Silva Vieira,
M. J. Saavedra,
J. Polido-Pereira,
R. A. Moura,
I. Alcobia,
J. E. Fonseca,
V. C. Romão

摘要

Objectives

With this work, we evaluated the impact of the Lisbon Early ARthritis cliNic (LEARN) on untreated inflammatory arthritis clinical and patient-reported outcomes.

Methods

A retrospective cohort study enrolled patients in LEARN since its inception. Patients were followed for 12 months and treated to achieve disease remission. Clinical, structural, and quality of life outcomes were assessed. The early arthritis module of the Portuguese Rheumatic Diseases Registry (Reuma.pt) is described.

Results

We assessed 292 patients between 2015 and 2022. Mean symptom duration and DAS-28-4 V-ESR at baseline were 6.2 ± 3.5 months and 5.6 ± 1.3, respectively. Rheumatoid arthritis (56.4%; 40.1% seropositive) and psoriatic arthritis (12.4%) were the most common diagnoses. Most patients were treated with methotrexate (75.3%) combined with low-dose oral prednisolone (88.1%). At 12 months, a mean ΔDAS28-4 V-ESR improvement of 2.3 ± 0.4 was registered, with 29.5% and 48.9% of patients achieving remission (DAS28-4 V-ESR < 2.6) or low disease activity (DAS28-4 V-ESR < 3.2), respectively. Among RA patients only, these figures were 20.6% and 46.6%, respectively. A clinically meaningful functional improvement was observed in 72.1% of the patients. Structural progression was limited, affecting only 16.1% of the patients. Fatigue, anxiety, depression, and quality of life also improved substantially, translated by improvements in FACIT, HADS, EQ5D, and SF-36 scores.

Conclusions

A structured, dedicated approach to patients with early arthritis resulted in good clinical, structural, and functional outcomes. Furthermore, our findings suggest the window of opportunity for early intervention may have implications for mental health and global well-being.

Key Points

• Patient assessment is facilitated by reliable electronic clinical records, such as the early arthritis module of the Rheumatic Diseases Portuguese Register (Reuma.pt) which we describe here for the first time.

• Inflammatory arthritis was confirmed in the majority of patients observed, but the time to first appointment was above the recommended.

• Prompt start of conventional therapy allowed significant disease activity improvement and remission to be achieved in about one-third of the patients.

• Key patient-reported outcomes elucidate disease impact and confirm the benefit of early treatment initiation, suggesting a window of opportunity also for mental health and global well-being.