Early Rheumatoid Arthritis Characteristics Have Changed Over Last 20 Years

The baseline characteristics of patients with rheumatoid arthritis (RA) have shifted in the last 20 years toward less seropositivity and lower blood inflammation and more comorbidities, in new research that suggests secular and lifestyle trends have affected outcomes in patients with early RA.¹

“We wanted to explore whether part of the improvement in outcomes observed in the more recent years could also be associated with patient changes at the initial presentation of patients. Reports on the evolution over extended periods of time of baseline characteristics of early RA (ERA) patients are sparse and come from affluent, mostly White populations²,” lead investigator Nathalie Carrier, MSc, University of Sherbrooke, Quebec, Canada, and colleagues wrote.¹

Carrier and colleagues analyzed over 24 years of data encompassing of baseline clinical, immunogenetic, environmental, radiographic and patient-reported characteristics of consecutive patients with recent-onset polyarthritis recruited into the Early Undifferentiated PolyArthritis (EUPA) cohort. They defined 3 periods of time: prior to general biologic availability (1998-2004; n = 245), prior to 2010 classification criteria (2005-2010; n = 266), and the most recent decade (2011-2022; n = 329).¹

The investigators found that most characteristics of participants remained stable across the 3 periods, including demographics, BMI, swollen and tender joint counts, proportion fulfilling 2010 ACR⁄EULAR criteria, Modified Health Assessment Questionnaire (M-HAQ), shared epitope status, and patient-reported outcomes except pain and Patient Evaluation of Disease Activity (PGA). ¹

However, cardiovascular comorbidities (40.0 to 51.1%; P = .03) and prior cancer (excluding non-melanoma skin cancer; 4.1 to 9.4%; P = .19) increased in prevalence, although active smoking had markedly decreased over time (22.2% to 12.1% smokers; P = 0.04). The proportion of patients ever exposed to smoking did remain stable at above 60%. Additionally, disease-modifying antirheumatic drug use prior to inclusion remained low and stable (25.7%) and the use of oral corticosteroid use at baseline increased (18.0 to 33.4%; P <.01).¹

Participants’ duration of symptoms increased at baseline from 2.9 months to 4.1 months across the time periods (P <.001) despite the field’s efforts to increase early diagnosis of RA. PGA remained stable while evaluator global assessment of disease activity (EGA) increased in the 2011-2022 period. On the other hand, reported pain levels decreased from 59 to 53/100 (P = .05), essentially after 2011. There were no significant changes for functional impairment (M-HAQ), fatigue, depressive symptoms, anxiety, or sleep problems.

Investigators found that rheumatoid factor seropositivity decreased from 53.9% to 42.2% (P = .005) and C-reactive protein and erythrocyte sedimentation rate both significantly decreased. The prevalence of elevated baseline erosion scores significantly decreased from 18.3 to 9.4% (P <.001) and was obvious only for the 2011-2022 period, while elevated joint narrowing scores increased from 18.6 to 29.7% (P = .001) over the same period, resulting in total Sharp–van der Heijde (SvH) score, summing up erosion and narrowing, to remain relatively stable.¹

Looking at patients with seropositivity compared with those with seronegativity, Hanlon and colleagues found that the decrease in Erosive damage was statistically significant only in patients with seronegativity, who were older (65.9 years vs 59.1 years, P <.001), less frequently active smokers (13.2 vs 21.6%, P = .002), and had higher comorbidities (RDCI ≥1, 60.1 vs 46.6%, P<.001) than those with seropositivity. These patients also had less frequent SE alleles (37.6 vs 59.0%, P <.001), more frequent DERAA alleles (34.1 vs 19.3%, P <.001) and had lower Erosive status at baseline (12.4 vs 18.2%, P = .02).

The investigators noted that within the 2011-2022 period, they found characteristics of patients at baseline during the COVID-19 pandemic to be comparable with those prepandemic to allow them to keep the span as one time period.

“Our data underline the need for more pathogenic and therapeutic studies aimed at seronegative RA. The role of active smoking in RA development is clearly decreasing. Due to the increasing prevalence of comorbidities, particularly cardiovascular and neoplastic, we propose alternative pathogenic pathways, such as immune exhaustion, may be at play. Finally, whether these changes at diagnosis, especially seronegative and less erosive status, contributed to the improvements in outcomes observed over the last decades in EUPA patients merit further study,” Hanlon and colleagues concluded.1

REFERENCES

• Carrier N, Roux S, Masetto A, et al. Early Rheumatoid Arthritis Patients at Presentation Are Changing: A 24-Year Study of the Early Undifferentiated PolyArthritis (EUPA) Cohort. J Rheumatol. Published online September 15, 2024. doi:10.3899/jrheum.2024-0560
• Myasoedova E, Davis J, Matteson EL, Crowson CS. Is the epidemiology of rheumatoid arthritis changing? Results from a population-based incidence study, 1985-2014. Ann Rheum Dis. 2020;79:440-4