I am deeply grateful for the opportunity to contribute to rheumatoid arthritis (RA) research over the past two years through the generous support of Arthritis & Osteoporosis Western Australia (WA). My research work has focused on investigating the clinical epidemiological profile of RA in WA using linked health data spanning 1980 to 2015. This research aims to improve health outcomes and reduce hospital utilisation for people with RA.

My research has provided several key insights into the impact of RA on Western Australians:

Mortality Trends:

We have made significant progress in treating RA, with patients living longer than in previous decades. However, there is still a considerable gap to close. Our study revealed that the mortality rate for RA patients in Western Australia has decreased over time but remains 1.59 times higher than the general population in 2011-2015. This finding underscores the need for continued efforts to improve RA management and overall patient care.

Cardiovascular Risk:

One of the most striking findings of our research is the outsized role that cardiovascular disease plays in RA mortality. Heart problems have emerged as the leading cause of death among patients with RA, accounting for 26.6% of deaths. This highlights the critical importance of integrating cardiovascular risk management into RA care protocols. Heart health as an integral part of RA treatment, not a separate issue.

Comorbidities:

Our research clearly showed that comorbidities significantly impact the outcomes of RA patients. We found that patients with a Charlson’s comorbidity index score of 2 or higher had a 1.72 times higher risk of death. This emphasises the need for a holistic approach to RA care, one that addresses not only the joint inflammation characteristic of RA, but also manages other health conditions that can coexist with or arise from RA.

Impact of Biological DMARDs:

The introduction of biological Disease-Modifying Antirheumatic Drugs (bDMARDs) in 2003 has had a notable impact on RA treatment in WA. Our data show that bDMARDs were associated with a modest further decline in hospitalisations related to RA, beyond the reductions seen with conventional DMARDs. However, it is important to note that the high costs of biologics were not fully offset by hospitalisation cost savings. This finding underscores the need to carefully consider the cost-benefit ratio when prescribing these medications.

Adverse drug reactions:

Our research of adverse drug reactions (ADRs) associated with RA medications yielded some interesting gender-based differences. We found that ADRs, particularly methotrexate and infliximab, were reported more frequently in female RA patients. Specifically, 78.6% of the ADRs reported for methotrexate were in women, compared to 19.8% in males. For infliximab, ADRs were more common in older women (60-69 years) and younger males (≤19).

Additionally, we found that patients on biologics were 2.7 times more likely to report true adverse drug reactions compared to those on conventional DMARDs. The most frequently reported adverse reactions for biologics such as infliximab were flushing and nausea. These findings highlight the need for vigilant monitoring of patients taking these medications, with perhaps extra attention paid to women and those taking biologic therapies.

Regional Disparities:

Our research also shed light on the unique challenges faced by RA patients in regional areas of Western Australia. We found disparities in access to specialised care and treatment outcomes between urban and rural patients. This emphasises the need for targeted strategies to improve RA care in regional communities, possibly through telemedicine initiatives or outreach programmes.

Implications for Clinical Practice and Health Policy:

These findings have significant implications for how we approach RA care in WA. They highlight the need for:

1. Continued efforts to reduce excess mortality in RA through better disease control and management of comorbidities, especially cardiovascular risk factors.
2. Judicious use of biologic DMARDs, balancing their clinical benefits against high costs.
3. Careful monitoring for ADRs, particularly in female patients and those taking biologics.
4. Strategies to improve the care and outcomes for RA patients in regional areas.
5. A holistic approach to RA care that addresses not just joint inflammation, but overall patient health.

Future directions:

Looking ahead, our research has opened several exciting avenues for further investigation. We are particularly interested in exploring the long-term impacts of different treatment strategies on patient outcomes and quality of life. We are also keen to delve deeper into the reasons behind the gender disparities in ADRs and to investigate potential genetic or environmental factors that might influence RA progression and treatment response in the Western Australian population.

I am profoundly appreciative of the support that has enabled this impactful research. The opportunity to work alongside Professor Nossent and contribute to advancing our understanding of RA epidemiology and outcomes in WA. It has been invaluable for my professional growth and the broader field of rheumatology.