Clinical and functional status in 88 rheumatoid arthritis patients followed for 15 years or more by office-based (n = 41) or hospital-based (n = 47) physicians.

Abstract:

OBJECTIVE:To determine the very long-term clinical and functional outcomes in rheumatoid arthritis (RA) patients followed by office-based or hospital-based physicians. PATIENTS AND METHODS:A questionnaire including items on clinical outcomes (active disease, remission, burn-out) and the Health Assessment Questionnaire (HAQ) was mailed to 122 patients with RA of at least 15 years' duration; 61 were followed by office-based physicians and 61 by hospital-based physicians. In the 88 (72%) respondents, mean age was 63 +/- 13 years and mean disease duration was 20.1 +/- 8.7 years. RESULTS; None of the patients experienced burn-out of their disease, and only six (7%) met Pinals' remission criteria. However, 23 (26%) reported a current subjective remission with a mean duration of 8.5 +/- 5.9 months. Although the mean pain score in the 88 patients was 4.1 +/- 2.3, only 50 (56%) patients reported a physician visit during the last 6 months. HAQ scores varied widely, the mean being 1.11 +/- 0.84. Forty (46%) patients had a history of arthroplasty (knee or hip in 29 (33%)). Of the 34 nonrespondents, seven had died (at a mean age of 74 years), and in four of these seven the cause of death was infection or immobility-related complications; in the 27 survivors, disease activity was considered minimal by the physicians or patients, 11 (41%) patients believed they were in remission, and mean time since the last physician visit was 3.9 years. Conclusion. Although burn-out within 20 years of RA onset seems exceedingly rare, clinical activity is milder than in early RA; over one-fourth of our patients believed they were in remission and over one half had not seen a physician during the last 6 months. Functional outcomes varied widely across patients but were acceptable overall, a result that is partly ascribable to the favorable effects of surgery. No differences in functional outcomes were found between patients followed by office-based physicians and those followed by hospital-based physicians.

journal_name

Joint Bone Spine

journal_title

Joint bone spine

authors

Laborie Y,Berthelot JM,Alliaume C,Baron J,Caumon JP,Desmas V,Rossard A,Maugars Y,Prost A

doi

10.1016/s1297-319x(02)00370-6

subject

Has Abstract

pub_date

2002-03-01 00:00:00

pages

181-8

issue

2

eissn

1297-319X

issn

1778-7254

journal_volume

69

pub_type

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