Long-Term Outcomes in Puerto Ricans with Rheumatoid Arthritis (RA) Receiving Early Treatment with Disease-Modifying Anti-Rheumatic Drugs using the American College of Rheumatology Definition of Early RA



Noemí Varela-Rosario1, Mariangelí Arroyo-Ávila1, Ruth M. Fred-Jiménez1, Leyda M. Díaz-Correa1, Naydi Pérez-Ríos2, Noelia Rodríguez1, Grissel Ríos1, Luis M. Vilá1, *
1 Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
2 Puerto Rico Clinical and Translational Research Center, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico


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© 2017 Varela-Rosario et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Luis M. Vilá, MD, Chief and Program Director, Division of Rheumatology, University of Puerto Rico Medical Sciences Campus; PO Box 365067; San Juan; PR 00936-5067; Tel: 787-758-2525, ext. 1825; Fax: 787-764-6839; E-mail: luis.vila2@upr.edu


Abstract

Background:

Early treatment of rheumatoid arthritis (RA) results in better long-term outcomes. However, the optimal therapeutic window has not been clearly established.

Objective:

To determine the clinical outcome of Puerto Ricans with RA receiving early treatment with conventional and/or biologic disease-modifying anti-rheumatic drugs (DMARDs) based on the American College of Rheumatology (ACR) definition of early RA.

Methods:

A cross-sectional study was performed in a cohort of Puerto Ricans with RA. Demographic features, clinical manifestations, disease activity, functional status, and pharmacotherapy were determined. Early treatment was defined as the initiation of DMARDs (conventional and/or biologic) in less than 6 months from the onset of symptoms attributable to RA. Patients who received early (< 6months) and late (≥6 months) treatments were compared using bivariate and multivariate analyses.

Results:

The cohort comprised 387 RA patients. The mean age at study visit was 56.0 years. The mean disease duration was 14.9 years and 337 (87.0%) patients were women. One hundred and twenty one (31.3%) patients received early treatment. In the multivariate analysis adjusted for age and sex, early treatment was associated with better functional status, lower probability of joint deformities, intra-articular injections and joint replacement surgeries, and lower scores in the physician’s assessments of global health, functional impairment and physical damage of patients.

Conclusion:

Using the ACR definition of early RA, this group of patients treated with DMARDs within 6 months of disease had better long-term outcomes with less physical damage and functional impairment.

Keywords: Rheumatoid arthritis, Early Treatment, Disease-Modifying anti-rheumatic drugs, Clinical Outcome, Hispanics, Puerto Ricans.