Quality of life in patients with rheumatoid arthritis
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Rheumatoid arthritis (RA) is a chronic, disabling, inflammatory polyarthritis that affects patient well-being and QOL. Many disease-modifying antirheumatic drugs (DMARDs) are available for treating RA but patients are often refractory to treatment. The goal of treatment is to improve both general health and health-related QOL. Generic and disease-specific instruments exist to measure QOL. Using these instruments, one can determine if QOL improves with treatment. If the minimal clinically important difference (MCID) for the instrument is known, one can determine if the change is clinically significant.
The literature was reviewed in a systematic manner to determine which drugs could affect QOL in patients with refractory RA. Refractory RA is poorly defined but we used the definition of failing at least two DMARDs. Methotrexate, leflunomide, cyclosporin, glucocorticoids, etanercept and infliximab clinically and statistically significantly improved QOL in patients with RA. Gold and epoetin-α (erythropoietin) statistically improved QOL in patients with RA but the clinical significance of the improvements could not be determined. These studies were either in non-refractory populations or the refractoriness could not be determined. Further study is required to determine the response of QOL to treatment in patients with refractory RA and instruments with known MCIDs should be used so that the clinical significance of the improvement can be determined.
The authors would like to thank Jessie McGowan for her assistance with the literature search for this article. Dr Tugwell is a paid consultant for and has received grants from a variety of pharmaceutical companies. There was no specific funding for this study.
- 13.Tugwell P, Wells G, Strand V, et al. Clinical improvement as reflected in measures of function and health-related quality of life following treatment with leflunomide compared with methotrexate in patients with rheumatoid arthritis: sensitivity and relative efficiency to detect a treatment effect in a twelvemonth, placebo-controlled trial. Arthritis Rheum 2000; 43 (3): 506–14PubMedCrossRefGoogle Scholar
- 14.Pouchot J, Guillemin F, Coste J, and the French Quality of Life Rheumatology Group, et al. Validity, reliability and sensitivity to change of a French version of the arthritis impact measurement scales2 (AIMS2) in patients with rheumatoid arthritis treated with methotrexate. J Rheumatol 1996; 23: 52–60PubMedGoogle Scholar
- 26.Peeters HRM, Jongen-Lavrencic M, Bakker CH, et al. Recombinant human erythropoietin improves health-related quality of life in patients with rheumatoid arthritis and anaemia of chronic disease; utility measures correlate strongly with disease activity measures. Rheumatol Int 1999; 18: 201–6PubMedCrossRefGoogle Scholar