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Health-related quality of life and functional ability in patients with early arthritis during remission steered treatment: results of the IMPROVED study

Lotte Heimans1*, Kirsten VC Wevers-de Boer1, KK Michel Koudijs1, Karen Visser1, Yvonne P Goekoop-Ruiterman2, Joop B Harbers3, Gerda M Steup-Beekman4, Leroy R Lard5, Bernard AM Grillet6, Tom WJ Huizinga1 and Cornelia F Allaart1

Author Affiliations

1 Department of Rheumatology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands

2 Department of Rheumatology, Haga Hospital, Leijweg, 275, 2545 CH, The Hague, The Netherlands

3 Department of Rheumatology, Franciscus Hospital, PO Box 999, 4700 AZ, Roosendaal, The Netherlands

4 Department of Rheumatology, Bronovo Hospital, Bronovolaan, 5, 2597 AX, The Hague, The Netherlands

5 Department of Rheumatology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands

6 Department of Rheumatology, ZorgSaam Hospital, Wielingenlaan, 2, 4535 PA, Terneuzen, The Netherlands

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Arthritis Research & Therapy 2013, 15:R173  doi:10.1186/ar4361

Published: 31 October 2013



The aim of this study was to investigate patient reported outcomes (PROs) of functional ability and health related quality of life (HRQoL) in patients with early (rheumatoid) arthritis during one year of remission steered treatment.


In this study, 610 patients with early rheumatoid arthritis (RA) or undifferentiated arthritis (UA) were treated with methotrexate (MTX) and tapered high dose of prednisone. Patients in early remission (Disease Activity Score (DAS) <1.6 after 4 months) tapered prednisone to zero and when in persistent remission, also tapered MTX. Patients not in early remission were randomized to either MTX + hydroxychloroquine + sulphasalazine + prednisone (arm 1) or to MTX + adalimumab (arm 2). Every 4 months, patients filled out the Health Assessment Questionnaire (HAQ) and the McMaster Toronto Arthritis Patient Preference Questionnaire (MACTAR), the Short Form 36 (SF-36) and visual analogue scales (VAS). Change scores were compared between treatment groups. The association with achieving remission was analyzed using linear mixed models.


During year 1, patients who achieved early remission had the most improvement in PROs with scores comparable to the general population. Patients in the randomization arms showed less improvement. Scores were comparable between the arms. There was a significant association between achieving remission and scores of HAQ, MACTAR and physical HRQoL.


In early arthritis, PROs of functional ability and HRQoL after one year of remission steered treatment reach normal values in patients who achieved early remission. In patients not in early remission, who were randomized to two strategy arms, PROs improved less, with similar scores in both treatment arms.

Trial registrations

ISRCTN11916566 and EudraCT2006-006186-16