People with rheumatoid arthritis (RA) are likely to have a much better quality of life today than they did two decades ago, according to researchers in the Netherlands, who followed more than 1,100 patients diagnosed with RA between 1990 and 2011. They attribute the gains to earlier diagnosis, more aggressive medications and a greater emphasis on overall well-being. Their findings were published recently in Arthritis Care & Research.

Lead author Cecile Overman, a doctoral candidate at Utrecht University in the Netherlands, says she and her colleagues wanted to determine if improved treatments over the last 20 years led to better physical and psychological health for RA patients.  

In RA, the body's immune system mistakenly attacks the lining of the joints, leading to body-wide inflammation that damages not only the cartilage and bones, but also organs such as the heart and lungs as well. RA is also associated with depression and anxiety, which for some can be as limiting as physical disability. No cure for RA exists, but certain medications can improve symptoms and slow disease progress.

In the current study, researchers followed several groups of mostly female patients, aged 17 to 86, who were diagnosed with RA at different times over a 20-year period. All were assessed at diagnosis and after approximately four years of treatment (follow-up).

Disease activity was measured by the DAS28, a score that takes into account blood markers of inflammation and the number of painful and swollen joints present in each patient (the lower score, the better a patient is doing). Depression, anxiety and physical functioning were measured using validated patient questionnaires.    

Results showed that both mood and physical ability improved both after treatment and as the study progressed over time. For example, about 43 percent of people newly diagnosed with RA in 1990 reported feeling depressed, whereas 32 percent of those diagnosed in 2004 to 2008 did. At follow-up, the numbers were 25 and 14 percent, respectively. Physical disability was cut in half during the 20-year span.  

DAS28 scores decreased over the course of the study, too. Overman says that although the research does not prove cause-and effect, results suggest that the downward trend in physical disability, anxiety and depressed mood results from reduced disease activity. And that, in turn, is probably due to better treatments.

"In our study, as insights evolved, treatment strategies changed across the decades, with pharmacological treatment becoming more intense,” she says. “For example, to keep inflammation and disease progression to a minimum, patients start with stronger medications as soon as possible, are monitored more frequently, and medications are combined for optimal efficacy. Furthermore, when new anti-inflammatory drugs such as biologics became available, their use increased."

Researchers didn't examine the effect of any particular drug, but Overman says tumor necrosis factor (TNF) inhibitors such as etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira), were commonly prescribed in the later years of the study.