Long-term outcomes in Rheumatoid Arthritis: Review of data from the 'Basildon Inflammatory Arthritis Cohort'

Objective The aim was to determine outcomes in RA with long-term analysis of a real-world inception cohort. Methods We carried out a retrospective cohort analysis of 184 patients with a new diagnosis of RA (ACR/EULAR 2010 criteria) between 2009 and 2013. Measured parameters included patient demographics, serological markers, disease activity (DAS28-CRP), treatment regimen, development of new co-morbidities and all-cause mortality. Results Complete data were available for analysis in 171 patients, 60 men and 111 women, with a median age of 57 years and median follow-up time of 7.5 years. DAS-28 remission was achieved in 73%, with the majority continuing to require pharmacological therapy. Drug-free remission was achieved in 11.7%, whereas 3.5% remained refractory to treatment. Analysis of new co-morbidities revealed malignancy in 12.9% (n = 22), with lung cancer having the highest incidence (n = 9). Cardiovascular, pulmonary and cerebrovascular disease developed in 11.1% (n = 19), 5.8% (n = 10) and 5.3% (n = 9), respectively. The crude mortality rate was 19.3% (33 of 171), incidence mortality rate 174 per 10 000 person-years of follow-up and standardized mortality ratio 1.57 (95% CI 1.10, 2.17). More deaths were recorded from underlying malignancy [7.6% (n = 13)] than with cardiovascular disease [4.7% (n = 8)]. The majority of deaths occurred >= 5 years after initial diagnosis (67%). Conclusion Long-term analysis reveals that mortality in RA remains significantly elevated compared with the general population. Additionally, this real-world study underlines malignancy as the predominant cause of morbidity and mortality in RA. Lay Summary What does this research mean for patients? The aim of this study was to track the long-term disease course of patients with rheumatoid arthritis (RA) from the time of their diagnosis. We followed up 171 patients diagnosed with RA in our outpatient clinic between 2009 and 2013 for an average of 7 years. We focused on the course of their disease activity, any treatments they received and whether they developed any co-morbidities or mortality. We noted several observations that are of interest to both treating clinicians and patients. Around half of patients had a current or historical smoking status, underlining a major role for smoking in the development of RA. Most patients received some form of steroid therapy at the initial consultation to manage swollen joints, and methotrexate, sulfasalazine and hydroxychloroquine were required to maintain long-term control of the disease. The majority of patients achieved complete disease control by the end of the study period but continued to require some form of pharmacological therapy. Although several recent studies have demonstrated improving outcomes in the RA population overall, we show that development of malignancy (particularly lung cancer) and cardiovascular disease remain major contributors to morbidity and mortality.