Rheumatoid Arthritis Effects Persist Despite Treatment
Published: June 17, 2010
* Explain to interested patients that pain often persists with rheumatoid arthritis even when treatments achieve results considered successful by physicians' standards.
* Explain that patients volunteered to participate in the online survey, and the sample may therefore have been biased in some way.
* Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
ROME -- Even with treatment, women with rheumatoid arthritis (RA) still feel its negative effects on their lives and seek new sources of relief from pain and disability, a researcher said here.
A computer-based survey of nearly 2,000 women with rheumatoid arthritis in seven affluent Western countries found that 63% reported "pain on a daily basis," according to Vibeke Strand, MD, of Stanford University in Palo Alto, Calif.
And 49% said they wanted additional ways to obtain relief beyond medications they were already taking.
The latter finding "was very much an eye-opener to me," Strand told attendees at the European League Against Rheumatism meeting.
She added that, although biologic drugs had clearly made RA treatment more effective, "they are not doing as good a job as we'd like to think they could do."
The survey was carried out in August 2009 and was made available to more than 27,000 women participating in an online research panel; 1,958 completed the questionnaire.
Their mean age was 46 and three-quarters had been diagnosed with RA at least one year before.
Countries represented were the U.S., Canada, France, Italy, Germany, Spain, and Great Britain, with some 300 individuals from each nation except Canada, which contributed 155.
Respondents were asked to rate the impact of arthritis-related pain and disability on their ability to work and manage activities of daily living, to engage in hobbies, social activities, and intimate relationships.
The researchers found that:
* 87% of respondents regularly discussed ongoing pain with their healthcare providers
* 49% found at least some activities more difficult or impossible to do
* 23% had stopped working because of the disease
* 71% of those still working said they were less productive at work
* 24% reported difficulty sleeping
* 56% said their disease was emotionally distressing
* 40% reported feeling depressed much of the time
* 40% of single respondents said the disease made it more difficult to find a partner
* 22% of separated or divorced respondents said the disease played a role in the failure of the relationship
Strand noted that many of these effects are interrelated. For example, she said, sleep difficulties lead to increased fatigue, which in turn lowers pain thresholds.
She cautioned that the survey had several important limitations, including the potential for recruitment bias, the small sample size, and reliance on participants' report of the RA diagnosis.
On the other hand, Strand said, the findings were consistent across respondents from all the countries included in the sample. She added that similar results were scheduled to be presented here later in the meeting from a separate survey in Germany.
All in all, she said, "this has touched the tip of a very large iceberg."
Session co-moderator David Magnusson, vice chairman of the Swedish Rheumatism Association, commented that the findings weren't surprising.
"But I think it's important for this to get out because people don't think like that," he said.
Magnusson, who was not involved with the research, agreed that the potential for recruitment bias in the survey was real -- that patients with poorer symptom control might have been more inclined to participate than those whose treatment was more successful.
But he added that many patients also under-report the severity of symptoms.
On balance, Magnusson said, the findings reported by Strand probably reflect the average of patient experience fairly well.
"The research highlights the complexity of the management of RA, and the pain associated with RA, over and above basic symptom control," said Paul Emery, MD, president of EULAR and a rheumatologist at the University of Leeds in Britain, in a EULAR press release.
It is "of huge importance" to reduce pain, improve work productivity, and manage the social impact in patients with the disease, added Emery, who was a co-author of the study.
UCB Pharma supported the study.
Strand reported relationships with Abbott Immunology, Alder, Almirall, Amgen Corporation, AstraZeneca, BiogenIdec, CanFite, Centocor, Chelsea, Crescendo, Cypress Biosciences, Eurodiagnostica, Fibrogen, Forest Laboratories, Genentech, Human Genome Sciences, Idera, Incyte, Jazz Pharmaceuticals, Lexicon Genetics, Logical Therapeutics, Lux Biosciences, Novartis Pharmaceuticals, NovoNordisk, Nuon, Ono Pharmaceuticals, Pfizer, Rigel, Roche, sanofi-aventis, Savient, Schering-Plough, SKK, and UCB.
Emery reported relationships with UCB.
Magnusson reported no conflicts of interest.
Primary source: Annals of Rheumatic Disease
Strand V, et al "The impact of rheumatoid arthritis on women: focus on pain, productivity and relationships" Ann Rheum Dis 2010; 69: 748.