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Doctors discover clues in early RA to lost productivity later

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Patients with rheumatoid arthritis (RA) should suffer less hardship through work disability now that a Finnish study has identified risk factors that predict loss of productivity and those patients needing early aggressive treatment most.

Global assessments of the severity of RA ⩾50 by patients and doctors and HAQ scores ⩾1 at baseline were the disease variables, plus low education and older age, that predicted lost productivity in multivariate analysis in the controlled prospective follow up FIN-RACo trial.

Treatment with combination disease modifying antirheumatic drugs (DMARDs) and prednisolone over two years protected to some extent against lost productivity over treatment with a single DMARD (odds ratio 0.59) at five years’ follow up.

Global assessments have seldom been measured before in studies of outcome in RA. HAQ scores showed similar results to previous studies, but here proved a better indicator of lost productivity than single clinical variables. To measure lost productivity more accurately cumulative disability days per patient observation year, proportionate to loss of productivity, were calculated.

Patients with active RA for less than two years, who had not received DMARDs, were assessed according to number of sick days and RA related permanent disability pension. Initially they had sulfasalazine, methotrexate, hydroxychloroquine in combination or sulfasalazine alone; after two years treatment was unrestricted, and 48 patients switched to combination drugs. At entry 80 patients receiving combination and 82 single treatments were working or available for work.

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