Disease Progression and Treatment Responses in a Prospective DMARD-naive Seropositive Early Rheumatoid Arthritis Cohort: Does Gender Matter?

Journal of Rheumatology - Tập 37 Số 12 - Trang 2475-2485 - 2010
Damini Jawaheer1, Paul Maranian2,3,4,5,6,7,8,9,10,11, Grace Park2,3,4,5,6,7,8,9,10,11, Maureen Lahiff2,3,4,5,6,7,8,9,10,11, Sogol Amjadi2,3,4,5,6,7,8,9,10,11, Harold E. Paulus2,3,4,5,6,7,8,9,10,11
1Center for Neurobehavioral Genetics, and Division of Rheumatology, University of California at Los Angeles, USA.
2Amgen, Inc., Thousand Oaks
3CA, USA
4Center for Genetics, Children's Hospital Oakland Research Institute, 5700 Martin Luther King Jr. Way, Oakland, CA 94609-1609, USA.
5Center for Neurobehavioral Genetics, University of California at Los Angeles, currently Center for Genetics, Children's Hospital Oakland Research Institute; P. Maranian, MS;
6Center for Neurobehavioral Genetics, and the Division of Rheumatology, University of California at Los Angeles; the Center for Genetics, Children's Hospital Oakland Research Institute, Oakland;
7Division of Rheumatology, University of California at Los Angeles; G. Park, PhD, Division of Rheumatology,
8NIH Multipurpose Arthritis and Musculoskeletal Disease
9School of Public Health, University of California at Berkeley, California, USA
10School of Public Health, University of California at Berkeley
11University of California at Los Angeles, currently Amgen Inc.;

Tóm tắt

Objective.To assess gender differences in disease characteristics and treatment responses over time in a disease-modifying antirheumatic drug (DMARD)-naive seropositive early rheumatoid arthritis (RA) cohort.Methods.Patients with polyarticular disease who were DMARD-naive and had seropositive early RA (< 14 months) were recruited by the Western Consortium of Practicing Rheumatologists. Each patient was examined at study entry, after 6 and 12 months, and yearly thereafter. Clinical and demographic data were collected. We investigated gender differences in baseline disease characteristics and treatment using chi-squared, Mann-Whitney U, and t tests. We used generalized estimating equations (GEE) models for repeated measures to examine whether the rate of change of specific disease outcomes during the first 2 years after DMARD initiation was significantly influenced by gender.Results.At baseline, men (n = 67) and women (n = 225) had similar disease activity and radiographic damage; men, however, had significantly worse erosion, while women had worse joint space narrowing. Despite similar treatment, women had worse disease progression over the 2-year followup, as assessed by trends in Disease Activity Score 28/erythrocyte sedimentation rate (DAS28-ESR4), physician global scores, and tender joint counts. In the GEE model, gender was significantly associated with the rate of change of DAS28-ESR4 scores (p = 0.009), although not independently associated with disease activity. Self-reported measures (Health Assessment Questionnaire-Disability Index, patient global scores, fatigue, pain) were worse among women at baseline and throughout the study period. Men were more likely to achieve remission.Conclusion.At baseline, men and women had similar disease activity and joint damage. Responses to treatment over time were better among men in this prebiologic era; women had worse progression despite similar treatment.

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Journal of Rheumatology

Tập 37 Số 12

2475-2485

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