Difficult to treat rheumatoid arthritis in a comprehensive evaluation program: frequency according to different...

Area of Science:

• Rheumatology
• Immunology
• Clinical Medicine

Background:

• Difficult-to-treat Rheumatoid Arthritis (RA-D2T) presents a significant challenge, with patients failing to reach treatment targets despite advanced therapies.
• Comprehensive evaluation including clinical, serological, and imaging data is crucial for understanding RA-D2T.
• Assessing the frequency and predictors of RA-D2T is essential for optimizing patient management.

Purpose of the Study:

• To estimate the frequency of RA-D2T in a comprehensively evaluated cohort.
• To identify clinical, serological, and imaging characteristics associated with RA-D2T.
• To analyze the predictive value of baseline characteristics and therapeutic behaviors for RA-D2T at one-year follow-up.

Main Methods:

• A cross-sectional and prospective study design was employed, including consecutive Rheumatoid Arthritis (RA) patients.
• Patients were evaluated at baseline and after one year using multiple assessment tools: DAS28, CDAI, SDAI, Ultrasonography (US), and Health Assessment Questionnaire (HAQ).
• Logistic regression analysis was used to identify independent predictors of RA-D2T.

Main Results:

• At baseline, 27.5% of patients met the criteria for RA-D2T across all assessed parameters. Anemia, high rheumatoid factor (RF) titers, and higher HAQ scores were independently associated with RA-D2T.
• After one year, the frequency of RA-D2T increased to 33%. Specific indicators like D2T-US (14%) and D2T-HAQ (18.4%) showed significant prevalence (p < 0.001).
• Predictive factors for RA-D2T at one year included ACPA positivity (OR: 13.7) and X-ray erosion (OR: 2.9). For D2T-US, X-ray erosion was a strong predictor (OR: 19.7).

Conclusions:

• The frequency of RA-D2T varies depending on the objective parameters used for assessment (scores, imaging).
• Baseline characteristics such as ACPA positivity and radiographic erosions are significant predictors of persistent difficult-to-treat RA.
• Treatment strategies for RA-D2T often involve conventional DMARDs, corticosteroids, and TNF-blockers, with JAK inhibitors being frequently used for treatment switching.