FUNCTIONAL ABILITY AND QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS RECEIVING TOCILIZUMAB THERAPY

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease causing joint dysfunction; reduction of quality of life (QoL); loss of work ability, self-care ability, and executing daily routines in most patients 5–10 years after the disease onset.Objective. To study QoL and the functional status (FS) of Russian RA patients receiving tocilizumab (TCZ).Material and Methods. The study involved 42 patients with verified RA diagnosis (moderate or high activity) who had earlier undergone inefficient therapy with basic anti-inflammatory medications. The limitation of the FS of the RA patients was determined quantitatively using the Russian-language version of the HAQ questionnaire. QoL was evaluated using the EuroQol-5D (EQ-5D) Quality of Life questionnaire prior to treatment and after 4, 8, 12, 16, 20, and 24 weeks.Results. TCZ therapy demonstrated a rapid improvement of the FS of RA patients with a 64% decrease in the HAQ index (ΔHAQ=1.12), which corresponded to a 50% improvement of the health status of patients according to the ACR criteria.The median value [25th; 75th percentile] of the EQ-5D index was 0.52 [-0.02; 0.52]; 27.7% patients assessed their QoL as “worse than death”. The index reliably increased by week 8 of therapy; there were no patients with the negative EQ-5D index by week 24. Depending on QoL, all the patients were subdivided into two groups. Group 1 (n=12) comprised the patients with the EQ-5D no higher than 0; in group 2 patients (n=30), it was higher than 0. The groups were comparable in terms of disease duration, age, disease activity indices, and the previous treatment. The low QoL index in all 12 patients in group 1 was attributed to the infeasibility of performing daily activities and the reliably higher pain level (75.0 [61.0; 86.0] and 66.0 [48.0; 71.0] in groups 1 and 2, respectively; p=0.02). Improved QoL and reduced pain level were observed in both groups as early as after the first TCZ infusion. By week 24, the pain level decreased to 26.5 [11.0; 24.0] and 10.0 [2.0; 31.0] in groups 1 and 2, respectively. The EQ-5D index in group 1 became positive by week 8 of therapy.Conclusion. TCZ therapy quickly improves the FS and QoL of RA patients, including those with the most severe condition.

Keywords

• rheumatoid arthritis
• tocilizumab
• quality of life
• functional status