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A Swedish register-based, long-term inception cohort study of patients with rheumatoid arthritis - results of clinical relevance

Journal article
Authors I. Hafstrom
S. Ajeganova
M. L. E. Andersson
S. V. Bala
Stefan Bergman
A. Bremander
K. Forslind
K. Malm
B. Svensson
Published in Open Access Rheumatology-Research and Reviews
Volume 11
Pages 207-217
ISSN 1179-156X
Publication year 2019
Published at Institute of Medicine, School of Public Health and Community Medicine
Pages 207-217
Language en
Keywords patient reported outcomes, PRO, disease progression, prognostic factors, lifestyle, observational, low-dose prednisolone, disease-activity, joint destruction, alcohol-consumption, remission, severity, women, onset, mortality, smoking, Rheumatology
Subject categories Health Sciences, Clinical Medicine


Purpose: At the end of the twentieth century, the outcome of rheumatoid arthritis (RA) was shown to be unsatisfactory and new therapeutic strategies were introduced. This initiated a register-based long-term study of early RA, the Better Anti-Rheumatic PharmacOTherapy (BARFOT) study. The aims were to evaluate the disease course and to acquire knowledge for improved care. Patients and methods: BARFOT is a multicentre observational study of patients with early RA, consecutively included 1992-2006. The patients are followed in daily practice according to a structured protocol for 15 years and data recorded in a web-based register. Also, through linkage of the BARFOT register to national registers we have acquired information on comorbidity and mortality. Results: In all, 2857 patients have been included and over 80 scientific articles have been published. Phenotypic characteristics at disease onset, i.e. gender, smoking habits and autoantibody profiles have been addressed. The disease course over 15 years was described. Early predictors for persistent disease activity, impaired function, joint damage and comorbidities have been identified. Treatment strategies have been studied. A randomized sub-study gave strong support for the treatment of recent RA with low-dose prednisolone in combination with disease-modifying anti-rheumatic drug. Furthermore, the impact of lifestyle factors, such as smoking, alcohol consumption, body weight and physical activity has been addressed. Conclusion: A register-based study like BARFOT has provided a basis for optimal long-term management of patients with RA. In addition, the register has made it possible to perform a diversity of studies of RA addressing various issues of major relevance to the patients.

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