Eswar Krishnan, MD M.Phil

Publication Details

  • Disability in rheumatoid arthritis in the era of biological treatments ANNALS OF THE RHEUMATIC DISEASES Krishnan, E., Lingala, B., Bruce, B., Fries, J. F. 2012; 71 (2): 213-218


    Rheumatoid arthritis (RA) is a disabling disease. The authors studied the impact of new, expensive and occasionally toxic biological treatments on disability outcomes in real-world populations of patients with RA.The authors analysed Health Assessment Questionnaire Disability Index data on 4651 adult patients with RA collected prospectively from 1983 to 2006. They studied trends in disability using multilevel mixed-effects multivariable linear regression (mixed) models that adjusted for the effects of time trends in gender, ethnicity, age, smoking behaviour and disease duration.Overall, the patients were predominantly female (76%), were predominantly white (88%), had 13 years of education and have had RA for 13 years, on average. The time period from 1983 to 2006 saw major increases in the use of disease-modifying agents and biological agents, and a decrease in smoking. After adjustments, the disability rates declined at annual rates of 1.7% (1.5-1.8%) overall and 2.7% (2.4-3.1%) among men. The annual rate of disability declines in the biological era was greater than that in the preceding period, suggesting accelerated improvement. These declines were documented in all patient subgroups such as men, women, African-Americans, obese, older age groups and early disease (p<0.001), but not among the 1401 patients (where disability remained stable) who died on follow-up.Aggressive use of traditional disease-modifying agents and introduction of biological agents were associated with substantial gains in disability outcomes. Our finding supports the prevailing notion that 'tight inflammation control' is a desirable therapeutic strategy.

    View details for DOI 10.1136/annrheumdis-2011-200354

    View details for Web of Science ID 000298681800009

    View details for PubMedID 21953343

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