The emphasis on treating rheumatoid arthritis (RA) intensively reduces disease activity but its impact in routine care is uncertain. We evaluated temporal changes in disease activities and outcomes in a 10-year prospective observational cohort study of patients in routine care at one unit. The Guy’s and St Thomas’ RA cohort was established in 2005. It involved most RA patients managed in this hospital. Clinical diagnoses of RA were made by rheumatologists. Patients were seen regularly in routine care. Each visit included measurement of disease activity scores for 28 joints (DAS28), health assessment questionnaire scores (HAQ) and EuroQol scores. Patients received intensive treatments targeting DAS28 remission. In 1693 RA patients mean DAS28 scores fell from 2005 to 15 by 11% from 4.08 (95% CI: 3.91, 4.25) in 2005 to 3.64 (3.34, 3.78); these falls were highly significant (p < 0.001). DAS28 components: swollen joint counts fell by 32% and ESR by 24%; in contrast tender joint counts and patient global assessments showed minimal or no reductions. The reduction in DAS28 scores was predominantly between 2005 and 2010, with no falls from 2011 onwards. Associated with falls in mean DAS28s, patients achieving remission increased (18% in 2005; 27% in 2015) and the number with active disease (DAS28 > 5.1) decreased (25% in 2005; 16% in 2015). In 752 patients seen at least annually for 3 years, persisting remission (68 patients) and intermittent remission (376 patients) were associated with less disability and better health related quality of life. Over time biologic use increased, but they were used infrequently in patients in persistent remission. Over 10 years an intensive management strategy in a routine practice setting increased combination DMARD and biologic use: disease activity levels declined; this association is in keeping with a causal relationship. Patients who achieved remission, even transiently, had better functional outcomes than patients never achieving remission.

中文翻译：

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强化治疗对类风湿性关节炎疾病活动、残疾和健康相关生活质量的真实世界长期影响。

强调治疗类风湿性关节炎 (RA) 可大大减少疾病活动，但其对常规护理的影响尚不确定。我们在一项为期 10 年的前瞻性观察队列研究中评估了疾病活动和结果的时间变化，该研究对一个单位的常规护理患者进行了研究。Guy's and St Thomas' RA 队列成立于 2005 年。它涉及在这家医院管理的大多数 RA 患者。RA的临床诊断由风湿病学家作出。患者定期接受常规护理。每次访问包括测量 28 个关节的疾病活动评分 (DAS28)、健康评估问卷评分 (HAQ) 和 EuroQol 评分。患者接受了针对 DAS28 缓解的强化治疗。在 1693 名 RA 患者中，平均 DAS28 评分从 2005 年下降到 15 分，下降了 11%，从 2005 年的 4.08 (95% CI: 3.91, 4.25) 下降到 3.64 (3.34, 3.78)；这些下降非常显着（p < 0.001）。DAS28 成分：肿胀关节数下降 32%，ESR 下降 24%；相比之下，压痛关节计数和患者整体评估显示很少或没有减少。DAS28 分数的下降主要发生在 2005 年至 2010 年之间，从 2011 年起没有下降。与平均 DAS28 下降相关，达到缓解的患者增加（2005 年为 18%；2015 年为 27%），活动性疾病（DAS28 > 5.1）的数量减少（2005 年为 25%；2015 年为 16%）。在 752 名患者中，至少每年一次，为期 3 年，持续缓解（68 名患者）和间歇性缓解（376 名患者）与更少的残疾和更好的健康相关生活质量相关。随着时间的推移，生物制剂的使用增加，但它们很少用于持续缓解的患者。10 多年来，常规实践环境中的强化管理策略增加了 DMARD 和生物制剂的联合使用：疾病活动水平下降；这种关联符合因果关系。达到缓解（即使是暂时缓解）的患者比从未达到缓解的患者具有更好的功能结果。