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
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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
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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)
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
40. Percent Changes In HAQ RCTs for registration of new DMARDs/biologics After Vibeke Strand
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42. Aggressive DMARD regimens Aggressive/Standard DMARDs Late RA BROSG Study Early DMARDs/pyramidal NSAIDs Early RA Utrecht Arthritis Cohort Study HAQ
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44. Explaining Relationships of HAQ Joint damage act as “regulator” Sets disability level in which day-to-day variation occurs Synovitis Joint damage Disability
48. X-ray Progression Studies using Sharp and Larsen Scores Single Centre Cross-Sectional Study Longitudinal Studies From 8 centres
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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
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
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