Comparison of characteristics and therapeutic efficacy in rheumatoid arthritis patients treated by rheumatologists and those treated by orthopedic surgeons under a team medicine approach at the same institute

Features of patients with rheumatoid arthritis whose debut joint is a foot or ankle joint: A 5,479-case study from the IORRA cohort

Background

Foot and ankle joint disorders are serious issues for patients with rheumatoid arthritis (RA). We compared the differences between patients with RA whose first symptom involved a foot or ankle joint (FOOT group) versus other joints (non-FOOT group) within the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort in our institute.

Patients and methods

In the IORRA survey conducted in April 2016, patients were invited to complete six questionnaires about their first symptom at RA onset, current foot or ankle symptoms, daily living activities, and mental health. Disease activity, clinical laboratory variables, functional disability, quality of life, use and ratio of anti-inflammatory and antirheumatic drugs, daily living activities and mental health were compared between the two groups.

Results

Among 5,637 Japanese patients with RA who participated in the IORRA survey on April 2016, 5,479 (97.2%) responded to the questionnaire regarding their debut joint. Of these patients, 2,402 (43.8%) reported that their first symptom of RA involved a foot or ankle joint. The FOOT group (n = 2,164) had higher disease activity, higher disabilities, lower quality of life, lower activities of daily living, and poorer mental health and used anti-inflammatory drugs at a higher rate and at higher doses compared with the non-FOOT group (n = 2,164). On the other hand, the use of medications to suppress the disease activity of RA was similar between the groups.

Conclusion

Clinicians should pay more attention to foot and ankle joints in daily practice so as not to underestimate the disease activity of RA.

Sites, frequencies, and causes of self-reported fractures in 9,720 rheumatoid arthritis patients: a large prospective observational cohort study in Japan

Sites, frequencies, and causes of self-reported fractures in Japanese patients with rheumatoid arthritis (RA) were evaluated in a prospective, observational cohort study. The incidence and cause of fracture differ by anatomical site, sex, and age. These differences may be considered in establishing custom strategies for preventing fractures in RA patients in the future.

PURPOSE

The literature contains limited data describing the details of fractures at different skeletal sites in patients with RA.

METHODS

We evaluated the details of fractures in Japanese RA patients on the basis of our Institute of Rheumatology Rheumatoid Arthritis cohort study in 9,720 RA patients (82 % women; mean age, 56 years) who were enrolled from 2000 to 2010. The details of fractures were obtained through biannual patient self-report questionnaires.

RESULTS

Over a mean duration of 5.2 years, 1,317 patients (13.5 %) reported 2,323 incident fractures comprising 563 (24.2 %) clinical vertebral fractures and 1,760 (75.8 %) nonvertebral fractures. Rib fractures were the most common fractures in men, followed by clinical vertebral and hip fractures; the most common fractures in women were clinical vertebral fractures, followed by rib, foot, and hip fractures. There was a significant difference between sexes in the rates of rib, clavicle, shoulder, and ankle fractures. Spontaneous event was the primary cause of clinical vertebral fracture (65.4 %), whereas falls were the primary cause of upper extremity (76.5 %) and lower extremity (57.8 %) fractures. Rates of clinical vertebral and hip fractures increased, while those of rib and foot fractures decreased with increasing age. Incidence of falls, as causes of nonvertebral fractures, also increased in older age groups.

CONCLUSION

Our results suggest that the causes of fractures may differ depending on anatomical site and that prevention of falls may be the most effective way to reduce upper and lower extremity fractures, especially in older patients with RA.

Analysis of direct medical and nonmedical costs for care of rheumatoid arthritis patients using the large cohort database, IORRA

OBJECTIVES

Our goal was to determine the annual direct medical and nonmedical costs for the care of patients with rheumatoid arthritis (RA) using data from a large cohort database in Japan.

METHODS

Direct medical costs [out of pocket to hospitals and pharmacies and for complementary and alternative medicine (CAM)] and nonmedical costs (caregiving, transportation, self-help devices, house modifications) were determined for RA patients who were participants in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) studies conducted in October 2007 and April 2008. Correlations between these costs and RA disease activity, disability level, and quality of life (QOL) were assessed.

RESULTS

Data were analyzed from 5,204 and 5,265 RA patients in October 2007 and April 2008, respectively. The annual direct medical costs were JPY132,000 [out of pocket to hospital (US$1 = JPY90 in 2007)], JPY84,000 (out of pocket to pharmacy), and JPY146,000 (CAM). Annual direct nonmedical costs were JPY105,000 (caregiving), JPY22,000 (transportation), JPY30,000 (self-help devices), and JPY188,000 (house modifications). Based on the utilization rate for each cost component, the annual medical and nonmedical costs for each RA patient were JPY262,136 and JPY61,441, respectively. Costs increased with increasing RA disease activity and disability level or worsening quality of life (QOL).

CONCLUSIONS

Based on the IORRA database, patients with RA bear heavy economic burdens that increase as the disease is exacerbated. The results also suggest that the increase in medical and nonmedical costs may be ameliorated by the proactive control of disease activity.