Severe functional declines, work disability, and increased mortality in seventy‐five rheumatoid arthritis patients studied over nine years

TLDR

The cohort comprised RA patients who had received early intraarticular thiotepa‑corticosteroid injections but were otherwise demographically and functionally comparable to RA patients without that therapy. The study followed 75 RA patients nine years after a comprehensive baseline assessment that included quantitative functional capacity measures. Over nine years, 92 % of survivors had markedly reduced overall functional capacity, 93 % had lower grip strength, and 84 % had prolonged button‑test times, while 85 % of patients under 65 who were working full‑time at onset became work‑disabled; mortality was elevated but comparable to other RA cohorts, with no excess neoplasia, and those who died had significantly poorer baseline functional scores.

Abstract

Seventy-five patients with rheumatoid arthritis (RA) were reviewed 9 years after an extensive evaluation which included quantitative measures of functional capacity. These patients had received multiple intraarticular injections of thiotepa with corticosteroids early in their course, but appear demographically and functionally similar to other RA patients who had not received this therapy. Severe morbidity was seen over the 9-year period in the 55 surviving patients, including significantly lower overall functional capacity in 92% of patients studied, lower grip strength in 93%, and longer button test results in 84%. Work disability occurred in 85% of patients under age 65 who had been working full-time at disease onset. There was increased mortality at the 9-year review, similar to most reported series of RA patients from referral centers; however, a significant increase in neoplasia, which was of concern because of the use of intraarticular thiotepa, was not seen. In terms of functional capacity, including responses to questions about ability to perform activities, walking time, and the button test, those patients who had died prior to review had significantly lower baseline values than did those who survived. Of the 75 patients, 20 had died and 51 had lost significant functional capacity over a 9-year period, documented by quantitative measures of functional capacity.