2. RA Outcomes
3. Summary Of Presentation
4. Relationships of RA Outcomes Disability Pain Damage 5. Specific Factors Related toPoor Outcome in RA
6. Disease Activity States
7. Assessing Disease Activity
8. Treatment Goals With Anti-Rheumatic Drugs Inflammation Disability Radiographs Severity(arbitrary units) Durationof Disease (years) Early 0 5 10 15 20 25 30 ACR Intermediate Late
9. Clinical Measures Swollen and Tender Joint Counts 28 Joint Index 66 Joint Index 10. Joint Counts in 503 RA patients Swollen Joints Tender Joints 11. Visual Analogue Pain Scores
None Worst Assessment 12. VAS Scores And Laboratory Measures VAS Pain VAS Patient Global ESR
13. Correlations of Clinical Measures
14. Combining Measures
15. Changes in DAS with TNF From Professor Piet Van Riel 16. Listening to Patients Self-Assessment can replace clinician assessment
17. What is functional outcome? Disability and Health Status
18. Measuring DisabilityMeasuring Instruments
19. Health Assessment Questionnaire Fries Contributionto Rheumatology 20. Components of HAQ Scores Results in 103 RA patients 21. Progression of HAQ Scores Four Key Studiesin Early RA Five Key Studies in Established RA 22. Annual Change in the HAQ 25 cases followedfor 5 yearsin London 105 cases followedfor 12 years in Holland 3 2 1 0 3 6 9 12 Disease Duration in Years HAQScore 23. Annual Increase of HAQ in Routine Practice Graphical Report of 13 studies 24. Limitations of Conventional Assessments Physician-measurement gives high placebo response
Scott and Strand, Rheumatology, 2002 25. Comparing HAQ with EuroQol Different distributions shown in 320 RA patients 26. Health Profiles in RA Nottingham Health Profile Nottingham Health Profile 27. Health Profiles in RA Nottingham Health Profile Nottingham Health Profile 28. HAQ scores over the course of RA Changing correlations with time Welsing et al, Arthritis Rheum, 2000
Increases Over 10 Years Changing Correlations HAQ Score Months 29. HAQ and DMARDs 12 Months data from leflunomide database (US 301) LEFLUN PL MTX 0.10 0.00 -0.10 -0.20 -0.30 Improvement 1 3 6 9 12 Change in HAQ score Months 30. HAQ And DMARDs 6 month individual changes in HAQ from leflunomide trial (MN 301) 31. HAQ and DMARDsAll phase III leflunomide trials (ITT analysis) 32. HAQ and DMARDsSustained changes in HAQ during 2 years leflunomide HAQ Scores MN 305(60 cases) MN 304(248 cases) US 301(97 cases) 33. Steroid/DMARD combinations in Early RA ARC (Kirwan) and Cobra studies ARC Cobra 34. Steroid/DMARD combinations in Late RA Adding IM Depomedrone to DMARDs Choy et al, Ann Rheum Dis, 2005
35. DMARD CombinationsAdding leflunomide to MethotrexateKremer et al, J Rheum, 2004
36. DMARD combinations in Early RA FinRA-Co and MTX/SZP ( Maillefert)studies FinRA-Co MTX/SZP 37. HAQ and Anti-TNF 3-year enbrel therapy in 671 patients Baumgartner et al, J Rheum, 2004 0 6 12 18 24 30 36 0.8 1.2 1.6 0.4 HAQ Scores Months Early Established 38. Anti-TNF and HAQ Systematic Review for NICE appraisal Moreland Wadjula Weinblatt Etanercept Attract Infliximab All trials -1.0 -0.5 0 0.5 1.0 Favours treatment Favours control 39. Comparative Changes in HAQ Leflunomide versus Anti-TNF 40. Percent Changes In HAQ RCTs for registration of new DMARDs/biologics After Vibeke Strand 41. Measuring Quality of Life Improves Assessments of Anti-TNF
Treatment Baseline RAQol Score 30 20 10 0 42. Aggressive DMARD regimens Aggressive/Standard DMARDs Late RABROSG Study Early DMARDs/pyramidal NSAIDs Early RA Utrecht Arthritis Cohort Study HAQ 43. Intensive versus routine treatmentTICORA trial in early RA Grigor et al, Lancet, 2004
44. Explaining Relationships of HAQ Joint damage act as regulatorSets disability level in which day-to-day variation occurs Synovitis Joint damage Disability 45. MeasuringDamage From normality to failed joints 46. Some X-ray Scoring Systems
47. Changes in Larsen Score in Early RA Average of two observers
48. X-ray Progression Studies using Sharp and Larsen Scores Single Centre Cross-Sectional Study Longitudinal Studies From 8 centres 49. Correlating Damage WithDisability 5 studies in early RA and 8 in late RA