An estimate of functional state in patients with rheumatoid arthritis

Introduction Rheumatoid arthritis is an inflammatory chronic disease that affects 0.5-1% of the population, many of whom develop disease as working-age adults. Material and methods The aim of examination was to estimate functional disability in patients with rheumatoid arthritis and relationship between radiological damage, disease duration, disease activity, functional disability. The examination involved 60 patients with rheumatoid arthritis, aged (53.92?7.06) of both genders (48 female, 12 male). The following varables were assessed at one time point: swollen and tender joint count, visual analogue scale for pain, erythrocite sedimentation rate, health assessment questionnaire (HAQ) score, anatomical stage and functional class according to Stenbrocker's criteria. Disease activity was expressed as 28 joint disease activity score (DAS28). Correlations were calculated by Spearman's coefficient of correlation. Results In our study 82% of the patients had II and III anatomical stage and 80% of the patients had II and III functional class according to Steinbrocker's criteria. The median HAQ score was 1.25 ?0.70, and the median DAS28 was 5.74?0.98. Poor functional status was observed in 37 (61.66%) of the patients with an HAQ score of = 2. Functional disability in patients with rheumatoid arthritis was most strongly related to the presence of pain (rs=0.338, p<0.01) and to a lesser extent to anatomical and functional stage, disease duration, disease activity. Discussion and Conclusion The results of the study show that functional disability significantly correlated with subjective pain score (rs=0.338, p<0.01). We observed strong correlation between functional disability presented by HAQ score and pain but no significant correlation with other common clinical variables used for rheumatoid arthritis patients evaluation such as disease duration, disease activity, radiological damage.

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Effect of disease duration and prior disease-modifying antirheumatic drug use on treatment outcomes in patients with rheumatoid arthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2018-214918 ◽

2019 ◽

Vol 78 (12) ◽

pp. 1609-1615 ◽

Cited By ~ 7

Author(s):

Daniel Aletaha ◽

Jen-fue Maa ◽

Su Chen ◽

Sung-Hwan Park ◽

Dave Nicholls ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Disease Duration ◽

Activity Index ◽

Health Assessment ◽

Disease Activity Index ◽

Response To Therapy ◽

Joint Disease ◽

Adalimumab Therapy ◽

Disease Modifying

ObjectivesTo determine if disease duration and number of prior disease-modifying antirheumatic drugs (DMARDs) affect response to therapy in patients with established rheumatoid arthritis (RA).MethodsAssociations between disease duration or number of prior DMARDs and response to therapy were assessed using data from two randomised controlled trials in patients with established RA (mean duration, 11 years) receiving adalimumab+methotrexate. Response to therapy was assessed at week 24 using disease activity outcomes, including 28-joint Disease Activity Score based on C-reactive protein (DAS28(CRP)), Simplified Disease Activity Index (SDAI) and Health Assessment Questionnaire Disability Index (HAQ-DI), and proportions of patients with 20%/50%/70% improvement in American College of Rheumatology (ACR) responses.ResultsIn the larger study (N=207), a greater number of prior DMARDs (>2 vs 0–1) was associated with smaller improvements in DAS28(CRP) (–1.8 vs –2.2), SDAI (–22.1 vs –26.9) and HAQ-DI (–0.43 vs –0.64) from baseline to week 24. RA duration of >10 years versus <1 year was associated with higher HAQ-DI scores (1.1 vs 0.7) at week 24, but results on DAS28(CRP) and SDAI were mixed. A greater number of prior DMARDs and longer RA duration were associated with lower ACR response rates at week 24. Data from the second trial (N=67) generally confirmed these findings.ConclusionsNumber of prior DMARDs and disease duration affect responses to therapy in patients with established RA. Furthermore, number of prior DMARDs, regardless of disease duration, has a limiting effect on the potential response to adalimumab therapy.

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Canadian Variation by Province in Rheumatoid Arthritis Initiating Anti–Tumor Necrosis Factor Therapy: Results from the Optimization of Adalimumab Trial

The Journal of Rheumatology ◽

10.3899/jrheum.091447 ◽

2010 ◽

Vol 37 (12) ◽

pp. 2469-2474 ◽

Cited By ~ 12

Author(s):

CHRISTOPHER PEASE ◽

JANET E. POPE ◽

CARTER THORNE ◽

BOULOS PAUL HARAOUI ◽

DON TRUONG ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Tumor Necrosis Factor ◽

Tumor Necrosis ◽

Health Assessment ◽

Provincial Government ◽

Joint Disease ◽

Tender Joint Count ◽

Tender Joint ◽

Canadian Provinces ◽

Necrosis Factor

Objective.We compared variations among Canadian provinces in rheumatoid arthritis (RA) initiating anti-tumor necrosis factor (TNF) therapy.Methods.Data were obtained from the Optimization of Humira trial (OH) and from the Ontario Biologics Research Initiative (OBRI). Baseline characteristics were compared between regions: Ontario (ON), Quebec (QC), and other provinces (OTH). We compared Ontario OH to OBRI patients who were initiating anti-TNF therapy.Results.In 300 OH patients, mean age was 54.8 years (13.3). There were 151 (50.3%) ON patients, 57 from QC (19%), and 92 from OTH (30.7%). Regional differences were seen in the number of disease-modifying antirheumatic drugs (DMARD) ever taken (ON: 3.8 ± 1.4, QC: 3.1 ± 1.1, OTH: 3.3 ± 1.4; p < 0.001); swollen joint count (SJC; ON: 10.9 ± 5.9, QC: 9.0 ± 4.4, OTH: 11.3 ± 5.6; p = 0.033); tender joint count (TJC; ON: 12.2 ± 7.5, QC: 10.3 ± 5.7, OTH: 14.4 ± 7.6; p = 0.003); 28-joint Disease Activity Score (DAS28; ON: 5.8 ± 1.2, QC: 5.6 ± 1.0, OTH: 6.0 ± 1.1; p = 0.076); and Health Assessment Questionnaire (ON: 1.4 ± 0.7, QC: 1.7 ± 0.7, OTH: 1.5 ± 0.7; p = 0.060). DMARD-ever use differed: methotrexate (ON: 94.7%, QC: 93%, OTH: 84.8%; p = 0.025); leflunomide (ON: 74.8%, QC: 21.1%, OTH: 51.1%; p < 0.001); sulfasalazine (ON: 51%, QC: 38.6%, OTH: 25%; p < 0.001); myochrysine (ON: 9.3%, QC: 0%, OTH: 15.2%; p = 0.008); and hydroxychloroquine (ON: 67.5%, QC: 86%, OTH: 66.3%; p = 0.018). In comparison to ON OH patients, 95 OBRI patients initiating first anti-TNF had lower SJC (p = 0.017), TJC (p = 0.008), and DAS28 (p = 0.05).Conclusion.In Quebec, where access to anti-TNF is less restrictive, patients had lower SJC and TJC. ON used more DMARD, especially leflunomide, as mandated by the provincial government. Both provincial funding criteria and prescribing habits may contribute to differences. Canadian rheumatologists may vary in treatment decisions, but patients generally have similar DAS28 when initiating anti-TNF therapy.

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Has the Severity of Rheumatoid Arthritis at Presentation Diminished Over Time?

The Journal of Rheumatology ◽

10.3899/jrheum.131136 ◽

2014 ◽

Vol 41 (8) ◽

pp. 1590-1599 ◽

Cited By ~ 16

Author(s):

Janet G. Diffin ◽

Mark Lunt ◽

Tarnya Marshall ◽

Jacqueline R. Chipping ◽

Deborah P.M. Symmons ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Drug Exposure ◽

Functional Disability ◽

Health Assessment ◽

Joint Disease ◽

Symptom Duration ◽

Recent Onset ◽

American College Of Rheumatology ◽

Over Time

Objective.To examine the pattern of disease severity in patients with rheumatoid arthritis (RA) at presentation to the Norfolk Arthritis Register (NOAR) over 20 years.Methods.NOAR is a primary-care–based cohort of patients with recent-onset inflammatory polyarthritis. At baseline, subjects are assessed and examined by a research nurse. The Health Assessment Questionnaire (HAQ) is administered and the DAS28 (28-joint Disease Activity Score) is calculated. Information is collected on disease-modifying antirheumatic drug exposure. In this study, patients (symptom duration of < 2 years at baseline) were grouped into 4 cohorts (Cohort 1: 1990–1994; Cohort 2: 1995–1999; Cohort 3: 2000–2004; Cohort 4: 2005–2008). The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria for RA were applied retrospectively at baseline. Regression analyses were used to examine whether calendar year of presentation to NOAR was associated with baseline HAQ and DAS28 scores. Potential confounders included age at symptom onset, sex, rheumatoid factor, and anticyclic citrullinated peptide antibody positivity.Results.A total of 1724 patients met the ACR/EULAR 2010 RA criteria at baseline. Unadjusted mean DAS28 scores decreased over time. Calendar year of presentation to NOAR was significantly associated with lower DAS28 scores over time [Y = 4.51 + (–0.56 × year) + (0.44 × year2)]. Although unadjusted median HAQ scores increased over time, calendar year of presentation to NOAR was not significantly associated with HAQ scores [Y = (1.1) + (0.023 × year) + (0.05 × year2)]. Similar results were observed in each subpopulation of patients.Conclusion.While baseline disease activity has lessened slightly over time, there has been no improvement in baseline levels of functional disability.

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The Effect of Different Remission Definitions on Identification of Predictors of Both Point and Sustained Remission in Rheumatoid Arthritis Treated with Anti-TNF Therapy

The Journal of Rheumatology ◽

10.3899/jrheum.131451 ◽

2014 ◽

Vol 41 (8) ◽

pp. 1607-1613 ◽

Cited By ~ 14

Author(s):

Cheryl Barnabe ◽

Joanne Homik ◽

Susan G. Barr ◽

Liam Martin ◽

Walter P. Maksymowych

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index ◽

Joint Disease ◽

Tender Joint Count ◽

Sustained Remission ◽

Tender Joint ◽

Cross Sectional ◽

Das28 Remission

Objective.Predictors of remission in rheumatoid arthritis (RA) have been defined in cross-sectional analyses using the 28-joint Disease Activity Score (DAS28), but not with newer composite disease activity measures or using the more clinically relevant state of sustained remission. We have evaluated predictors of remission using cross-sectional and longitudinal durations of disease state, and by applying additional definitions of remission [American College of Rheumatology/European League Against Rheumatism Boolean, Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI)].Methods.Individuals in the Alberta Biologics Pharmacosurveillance Program were classified for the presence of remission (point and/or sustained > 1 yr) by each of the 4 definitions. Multivariate models were constructed including all available variables in the dataset and refined to optimize model fit and predictive ability to calculate OR for remission.Results.Nonsmoking status independently predicted point remission by all definitions (OR range 1.20–2.71). Minority ethnicity decreased odds of remission by DAS28 (OR 0.13) and CDAI (OR 0.09) definitions. Male sex was associated with DAS28 remission (OR 2.85), whereas higher baseline physician global (OR 0.67) and erythrocyte sedimentation rate values (OR 0.98) decreased odds of DAS28 remission. Higher baseline patient global score (OR 0.77) and swollen joint counts (OR 0.93) were negative predictors for CDAI remission. Higher baseline Health Assessment Questionnaire (OR 0.62) reduced odds for remission by the SDAI definition, and educational attainment increased these odds (OR 2.13). Sustained remission was negatively predicted by baseline physician global for the DAS28 (OR 0.80), and higher tender joint count (OR 0.96) for the CDAI.Conclusion.We demonstrate the influence of duration of remission state and remission definition on defining independent predictors for remission in RA requiring anti-tumor necrosis factor therapy. These predictors offer improved applicability for modern rheumatology practice.

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Predictor of the Simplified Disease Activity Index 50 (SDAI 50) at Month 3 of bDMARD Treatment in Patients with Long-Established Rheumatoid Arthritis

The Open Rheumatology Journal ◽

10.2174/1874312901711010106 ◽

2017 ◽

Vol 11 (1) ◽

pp. 106-112 ◽

Cited By ~ 1

Author(s):

Yusuke Miwa ◽

Mayu Saito ◽

Hidekazu Furuya ◽

Ryo Yanai ◽

Tsuyoshi Kasama

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Odds Ratio ◽

Disease Duration ◽

Activity Index ◽

Short Form ◽

Disease Activity Index ◽

Smoking History ◽

Tender Joint Count ◽

Tender Joint

Objectives:The Simplified Disease Activity Index (SDAI) 50 has good agreement with European League Against Rheumatism (EULAR) response measures for early Rheumatoid Arthritis (RA). There have been reports on early RA, but not on long-established RA. In this study, we analysed the relationships between various baseline factors and SDAI 50 after three months of treatment with biological disease-modifying antirheumatic drugs (bDMARDs) to determine the prognostic factors for long-established RA.Methods:Subjects were 260 RA patients who had been treated with bDMARDs for 3 months. The following characteristics were investigated: Patient backgrounds, the erythrocyte sedimentation rate (ESR), C-reactive protein and serum matrix metalloproteinase-3 levels, SDAI scores, and health assessment questionnaire disability index and short form-36 scores. As a primary outcome index, the SDAI response was defined as a 50% reduction in the SDAI score between baseline and 3 months (SDAI 50).Results:Baseline values of disease duration (odds ratio: 0.942, 95% CI: 0.902-0.984), smoking history (odds ratio: 2.272, 1.064-4.850), 28-tender joint count (odds ratio: 0.899, 0.827-0.977), evaluator's global assessment (odds ratio: 1.029, 1.012-1.047) and ESR (odds ratio: 1.015, 1.001-1.030) were determined to be significant factors based on logistic regression analysis.Conclusion:Our study demonstrated that RA patients with shorter disease duration, no smoking, and higher RA disease activity are more likely to achieve SDAI 50 through bDMARD treatment.

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Comparative Analyses of Serological Biomarkers and Disease Characteristics between Elderly-onset and Younger-onset Rheumatoid Arthritis

Medicine & Health ◽

10.17576/mh.2021.1601.19 ◽

2021 ◽

Vol 16 (1) ◽

pp. 237-245

Author(s):

Rajalingham Sakthiswary ◽

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Functional Disability ◽

Disease Duration ◽

Severe Disease ◽

Age At Onset ◽

Health Assessment ◽

Joint Damage ◽

Study Data ◽

Elderly Onset

The onset of rheumatoid arthritis (RA) may occur any time after the age of 16 years. The purpose of this study was to compare the clinical and serological differences between elderly onset RA (EORA); which is begins at the age of 60 and above, with younger onset RA (YORA). A total of 69 EORA and 82 YORA female patients were enrolled in this study. Data on medications, disease duration, age at onset, disease activity at onset and laboratory parameters were collected by reviewing the medical records. All patients had their blood samples taken for serum anticyclic citrulinated peptide (anti-CCP), IgA rheumatoid factor (RF), IgM RF and IgG RF. Besides, the subjects were assessed for their radiographic joint damage based on Modified Sharp Score (MSS) and functional disability based on the Health Assessment Questionnaire-disability Index (HAQ-DI) scores. Despite comparable disease duration and frequency of seropositivity, the YORA group had significantly higher disease activity at onset of the disease (p=0.009). In keeping with this finding, the YORA group had more severe joint damage based on radiographic assessment (MSS scores of 17.49+19.04 versus 10.04+12.79). The YORA group had significantly higher levels of IgA RF and anti-CCP with p-values of 0.035 and 0.002, respectively. Our findings suggest that YORA is associated with more severe disease, worse radiographic joint damage and higher levels of anti-CCP and IgA RF.

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Sleep Disturbances and Interleukin 6 Receptor Inhibition in Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.110617 ◽

2011 ◽

Vol 39 (1) ◽

pp. 60-62 ◽

Cited By ~ 42

Author(s):

KALLIOPI FRAGIADAKI ◽

MARIA G. TEKTONIDOU ◽

MARIA KONSTA ◽

GEORGE P. CHROUSOS ◽

PETROS P. SFIKAKIS

Keyword(s):

Rheumatoid Arthritis ◽

Sleep Quality ◽

Disease Activity ◽

Interleukin 6 ◽

Daytime Sleepiness ◽

Sleep Disturbances ◽

Functional Disability ◽

Health Assessment ◽

Joint Disease ◽

Interleukin 6 Receptor

Objective.Interleukin 6 (IL-6)-mediated interactions have been associated with sleep disturbances in healthy subjects. In this pilot study we examined whether administration of the IL-6 receptor antagonist tocilizumab in patients with rheumatoid arthritis (RA) affects sleep disturbances.Methods.Fifteen patients (13 women) with sleep disturbances at baseline received 6 monthly infusions of tocilizumab 8 mg/kg for moderately or severely active RA. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness by Epworth Sleepiness Scale, disease activity by the 28-joint Disease Activity Score-erythrocyte sedimentation rate, functional disability by Health Assessment Questionnaire Disability Index (HAQ-DI), and fatigue by the Functional Assessment of Chronic Illness Therapy (FACIT-Fatigue Scale; FFS) at baseline and first, second, third, and sixth month of treatment. Medications used before enrollment remained unchanged during followup.Results.Sleep quality improved and daytime sleepiness decreased significantly at first-month assessment (p < 0.00001 and p < 0.004, respectively, by repeated measurement analysis) compared to baseline, and these changes became more evident through 6 months. Disease activity decreased, fatigue decreased, and functional status improved significantly. Changes in PSQI score over time were not associated with the corresponding changes in DAS28-ESR (r = 0.37, p = 0.17), but correlated significantly with HAQ-DI changes (r = 0.60, p = 0.02) and marginally with changes in FFS scores (r = −0.46, p = 0.08).Conclusion.Improvement of sleep quality after tocilizumab treatment in patients with RA does not appear to directly result from decreased disease activity, further suggesting that aberrant IL-6 regulation is associated with sleep disturbances.

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Presence of salivary IgA anti-citrullinated protein antibodies associate with higher disease activity in patients with rheumatoid arthritis

Arthritis Research & Therapy ◽

10.1186/s13075-020-02363-0 ◽

2020 ◽

Vol 22 (1) ◽

Author(s):

Karin Roos Ljungberg ◽

Emil Börjesson ◽

Klara Martinsson ◽

Jonas Wetterö ◽

Alf Kastbom ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Blood Donors ◽

Severe Disease ◽

Joint Disease ◽

Tender Joint Count ◽

Tender Joint ◽

Radiographic Damage ◽

Salivary Iga ◽

Citrullinated Protein

Abstract Background Circulating IgA anti-citrullinated protein antibodies (ACPA) associate with more active disease, but a previous study implied that salivary IgA ACPA is related to a less severe disease. Therefore, we aimed to characterize the IgA ACPA response in the saliva and serum in relation to clinical picture and risk factors among patients with rheumatoid arthritis (RA). Methods RA patients (n = 196) and healthy blood donors (n = 101), included in the cross-sectional study “Secretory ACPA in Rheumatoid Arthritis” (SARA), were analyzed for ACPA of IgA isotype, and for subclasses IgA1 and IgA2 ACPA in paired saliva and serum samples using modified enzyme-linked immunosorbent assays (ELISA) targeting reactivity to a cyclic citrullinated peptide (anti-CCP). Cutoff levels for positive tests were set at the 99th percentile for blood donors. Antibody levels were related to clinical characteristics, radiographic damage, smoking habits, and carriage of HLA-DRB1/shared epitope (SE). Results IgA ACPA in the saliva was found in 12% of RA patients, IgA1 occurred in 10%, and IgA2 in 9%. In serum, IgA ACPA was found in 45% of the patients, IgA1 in 44%, and IgA2 in 39%. Levels of IgA ACPA in the saliva correlated significantly with serum levels of IgA (r = 0.455). The presence of salivary IgA ACPA was associated with a higher erythrocyte sedimentation rate (ESR), 28-joint disease activity score, tender joint count, and patient global assessment at the time of sampling. None of the antibodies was associated with smoking, SE, or radiographic damage. Conclusion Salivary IgA ACPAs were detected in a subset of RA patients in association with higher disease activity. This suggests that mucosal ACPA responses in the oral cavity may contribute to disease-promoting processes in RA.

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Neuropathic pain in a sample of Egyptian patients with rheumatoid arthritis

Egyptian Rheumatology and Rehabilitation ◽

10.1186/s43166-020-00047-w ◽

2020 ◽

Vol 47 (1) ◽

Author(s):

Abdullah Radwan ◽

Ahmed Borai

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Neuropathic Pain ◽

Disease Activity ◽

Functional Disability ◽

Disease Duration ◽

Univariate Analysis ◽

Health Assessment ◽

Reactive Protein ◽

Important Symptom

Abstract Background Rheumatoid arthritis (RA) is an autoimmune disease characterized by polyarthritis that may cause irreversible joint disability. Pain is the most important symptom in RA patients that requires more attention and careful evaluation. Despite the improvement in medications used to control inflammation in RA patients, a relevant number of them still experience neuropathic pain even with disease remission. This study was conducted to estimate the frequency of neuropathic pain (NP) in RA patients and to assess its relationship with disease activity, functional status, and overweight. Results NP was detected in 12.5% (14 patients) of RA patients. Highly significant differences were found between RA patients with NP and those without NP as regards disease duration, visual analog scale (VAS) of pain, disease activity score 28 (DAS28-ESR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), body mass index (BMI), health assessment questionnaire (HAQ) score, and Douleur Neuropathique in 4 (DN4) questionnaire for NP assessment (p < 0.001). The correlation between the DN4 questionnaire and the parameters of disease activity in RA patients with NP was not significant. By univariate analysis, the possible risk factors for NP in RA patients were disease duration, VAS, DAS28-ESR, HAQ, and BMI; however, by multivariate analysis, no possible risk factors for NP in RA patients were detected. Conclusion Although pain in patients with RA was classified as nociceptive in nature, a relevant proportion of patients might also have NP. NP in RA patients was related to functional disability, high disease activity, and overweight.

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Patients with Early Rheumatoid Arthritis in the 2000s Have Equal Disability and Pain Despite Less Disease Activity Compared with the 1990s: Data from the BARFOT Study over 8 Years

The Journal of Rheumatology ◽

10.3899/jrheum.161235 ◽

2017 ◽

Vol 44 (6) ◽

pp. 723-731 ◽

Cited By ~ 17

Author(s):

Maria L.E. Andersson ◽

Kristina Forslind ◽

Ingiäld Hafström

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Early Rheumatoid Arthritis ◽

Functional Disability ◽

Health Assessment ◽

Joint Disease ◽

Special Focus ◽

American College Of Rheumatology ◽

Hands And Feet ◽

Assessment Questionnaire

Objective.To compare outcomes over the first 8 years in patients with early rheumatoid arthritis (RA) recruited in the 1990s and the 2000s, with a special focus on functional disability and its possible predictors.Methods.Data were acquired from 1938 patients with early RA (American College of Rheumatology 1987 criteria) included in the BARFOT study, who had completed the 8-year followup. The patients were divided into 2 cohorts: cohort 1 (n = 928, 68% women) included from 1992 to 1999 and cohort 2 (n = 1010, 70% women) included from 2000 to 2006. Health Assessment Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), visual analog scale pain, and radiographs of hands and feet scored by the van der Heijde modified Sharp method were assessed during the 8 years. Longitudinal data analyses were performed using a generalized linear model.Results.Despite more active medical treatment during the 2000s, the courses of HAQ and pain showed no difference between the cohorts during followup, in either women or in men, with significantly higher levels in women compared with men. However, as expected, disease activity decreased more over time in cohort 2 compared with cohort 1, for both sexes, and women in cohort 2 had less radiographic progression compared with cohort 1. HAQ was associated with DAS28, pain, radiological scores, and sex in both cohorts, and in cohort 2 also with age and smoking.Conclusion.Patients included in the 2000s had lower disease activity, but not less activity limitation and pain over 8 years of followup despite more active treatment. Pain, aging, and smoking might explain why patients included in the 2000s still had the same disability levels as those included in the 1990s.

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