Costs and course of disease and function in early rheumatoid arthritis: a 3-year follow-up (the Swedish TIRA project)

Objective. To calculate direct and indirect costs and to study disease activity and functional ability over 3 yr in early rheumatoid arthritis (RA). Methods. Three hundred and three patients with early (<= 1 yr) RA were recruited during a period of 27 months (1996-1998). Data were recorded during 3 yr to assess disease activity, functional ability, medication, health-care utilization and days lost from work. Results. Within 3 months, improvements were seen regarding all recorded variables assessing disease activity and functional ability, but 15% had sustained high or moderate disease activity throughout the study period. Indirect costs exceeded direct costs in all 3 yr. The average direct costs were e 3704 (US$ 3297) in year 1 and e 2652 (US$ 2360) in year 3. All costs decreased, except those for medication and surgery. Compared with men, women had more ambulatory care visits and used more complementary medicine. The indirect costs were e 8871 (US$ 7895) in year 1 and remained essentially unchanged; this was similar for both sexes. Almost 50% were on sick leave or early retirement at inclusion. Sick leave decreased but was offset by an increase in early retirement. The 14 patients who eventually received TNF inhibitors incurred higher costs even before prescription of anti-TNF therapy. Conclusion. Disease activity and functional ability improved within 3 months after diagnosis of early RA. Direct costs decreased, except for medication and surgery. Indirect costs remained unchanged. Fifteen per cent of the patients had high or moderate disease activity in all 3 yr, indicating a need for more aggressive early anti-rheumatic therapy.