1. RA Outcomes King’s College Hospital

4. Relationships of RA Outcomes Disability Pain Damage

9. Clinical Measures Swollen and Tender Joint Counts 28 Joint Index 66 Joint Index

10. Joint Counts in 503 RA patients Swollen Joints Tender Joints

15. Changes in DAS with TNF From Professor Piet Van Riel

19. Health Assessment Questionnaire Fries Contribution to Rheumatology

20. Components of HAQ Scores Results in 103 RA patients

21. Progression of HAQ Scores Four Key Studies in Early RA Five Key Studies in Established RA

22. Annual Change in the HAQ 25 cases followed for 5 years in London 105 cases followed for 12 years in Holland 3 2 1 0 3 6 9 12 Disease Duration in Years HAQ Score

23. Annual Increase of HAQ in Routine Practice Graphical Report of 13 studies

25. Comparing HAQ with EuroQol Different distributions shown in 320 RA patients

26. Health Profiles in RA Nottingham Health Profile Nottingham Health Profile

27. Health Profiles in RA Nottingham Health Profile Nottingham Health Profile

29. HAQ and DMARDs 12 Months data from leflunomide database (US 301) LEFLUN PL MTX 0.10 0.00 -0.10 -0.20 -0.30 Improvement 1 3 6 9 12 Change in HAQ score Months

30. HAQ And DMARDs 6 month individual changes in HAQ from leflunomide trial (MN 301)

31. HAQ and DMARDs All phase III leflunomide trials (ITT analysis)

32. HAQ and DMARDs Sustained changes in HAQ during 2 years leflunomide HAQ Scores MN 305 (60 cases) MN 304 (248 cases) US 301 (97 cases)

33. Steroid/DMARD combinations in Early RA ARC (Kirwan) and Cobra studies ARC Cobra

36. DMARD combinations in Early RA FinRA-Co and MTX/SZP ( Maillefert) studies FinRA-Co MTX/SZP

37. HAQ and Anti-TNF 3-year enbrel therapy in 671 patients Baumgartner et al, J Rheum, 2004 0 6 12 18 24 30 36 0.8 1.2 1.6 0.4 HAQ Scores Months Early Established

38. Anti-TNF and HAQ Systematic Review for NICE appraisal Moreland Wadjula Weinblatt Etanercept Attract Infliximab All trials -1.0 -0.5 0 0.5 1.0 Favours treatment Favours control

39. Comparative Changes in HAQ Leflunomide versus Anti-TNF

40. Percent Changes In HAQ RCTs for registration of new DMARDs/biologics After Vibeke Strand

42. Aggressive DMARD regimens Aggressive/Standard DMARDs Late RA BROSG Study Early DMARDs/pyramidal NSAIDs Early RA Utrecht Arthritis Cohort Study HAQ

44. Explaining Relationships of HAQ Joint damage act as “regulator” Sets disability level in which day-to-day variation occurs Synovitis Joint damage Disability

45. Measuring Damage From normality to failed joints

48. X-ray Progression Studies using Sharp and Larsen Scores Single Centre Cross-Sectional Study Longitudinal Studies From 8 centres

51. Digression on Steroids: Historical Perspective Major Breakthrough in RA Over 50 Years Ago Philip Hench Edward Kendall Tadeus Reichstein “ it is still too early to judge what role cortisone may play as a remedy for cases of rheumatoid arthritis” Nobel Prize: Medicine, 1950 Presentation Speech by Prof Liljestrand ACTH Case From First Clinical Paper On Steroids in RA 45 year old female with severe RA for 5 years

52. New Role in 1990’s Combined with DMARDs In Early RA to Prevent Erosions Approaches Constant Low Dose Tapering High Dose Kirwan, NEJM, 1995 van Everdingen Ann Intern Med 2002 Boers, Lancet, 1997

53. IM Depomedrone In Established RA RCT Comparing 2-Years Monthly Depomedrone with Placebo in patients on DMARDs

55. 20 Year Results At Droitwich

57. Cause-Specific Mortality RA Deaths In 20 Year Follow-up Study 9003 Scottish RA inpatients 1981-2000 Thomas et al, J Rheumatol, 2003

58. Cause-Specific Mortality RA SMR in 20 Year Follow-up Study 9003 Scottish RA inpatients 1981-2000 Thomas et al, J Rheumatol, 2003

59. Cardiovascular Mortality in Women RA 114 342 nurses without heart disease and RA in 1976 After 20 years: 527 had RA, 2296 had MIs and 1326 strokes Solomon et al, Circulation, 2003

60. Mortality and Vascular Deaths RA, OA and No Arthritis From UK GP Database Women Men Watson et al, J Rheumatol, 2003

61. Deaths From Ischaemic Heart Disease SMR in 4 Studies of RA Patients

62. Deaths in Early Polyarthritis 1236 patients in NOAR Goodson et al, Arthritis Rheum, 2002

64. Cardiovascular Risk Factors Comparison of OA and RA Dessein et al, Arthritis Research, 2002

65. Alternative Assessment of Risk Factors in RA

66. Joint Swelling And Cardiovascular Deaths Prospective Study of 4120 Pima Indians Jacobsson et al, Arthritis Rheum, 2001 Joint swelling predicts CVD-related death Independent of other risks including diagnosis of RA Men Women

67. Predicting Mortality in RA 20 year study of 1381 Cases ESR Rheumatoid Factor Woolf et al, Arthritis Rheum, 2003 HAQ is another strong predictor

68. Mortality With DMARDs Risks compared to no DMARDs 1240 RA patients and 191 deaths Choi et al, Lancet, 2002

69. Deaths With Methotrexate Reduced CVS Mortality Choi et al, Lancet, 2002

70. Deprivation Predicts Death in RA Long Term Results from Glasgow

71. The patient's journey with RA Carol Simpson and Chloe Franks (patients) BMJ, October 2005