Difficult-to-Treat Rheumatoid Arthritis in Saudi Arabia: Clinical Characteristics and Associated Factors in a...

Difficult-to-treat rheumatoid arthritis (D2T RA) is a clinically challenging condition characterized by persistent disease activity despite appropriate disease-modifying antirheumatic drug (DMARD) therapy. Evidence regarding its frequency and contributing factors in Saudi Arabia remains limited.

To determine the proportion of patients with D2T RA and identify the demographic, clinical, laboratory, and treatment-related factors associated with it in a multicentre Saudi cohort.

This multicentre cross-sectional study used data from a registry of 928 patients with RA attending tertiary centres in Saudi Arabia. Patients were classified according to the EULAR definition as having D2T RA or controlled RA, defined as remission or low disease activity. Clinical, laboratory, and treatment-related characteristics were compared, and multivariable logistic regression identified factors independently associated with D2T RA.

Among 928 registry patients, 126 (13.6%) fulfilled the EULAR definition of D2T RA. For the comparative analysis, these patients were compared with 269 patients with controlled RA. D2T RA was associated with higher disease activity at the index visit, greater functional disability, elevated erythrocyte sedimentation rate, poorer patient global assessment, a longer interval between symptom onset and initial medical consultation, and lower treatment adherence. Joint deformities and swollen joint counts were more frequent, whereas C-reactive protein levels did not differ significantly. In multivariable analysis, age at diagnosis, longer disease duration, higher DAS28, greater Health Assessment Questionnaire disability, elevated erythrocyte sedimentation rate, poorer patient global assessment, treatment non-adherence, and methotrexate and glucocorticoid use were independently associated with D2T RA.

Among patients with established RA and prolonged follow-up, 13.6% fulfilled the D2T RA criteria. D2T RA was associated with persistent inflammatory activity, accumulated disease burden, a longer interval before the first medical consultation, and potentially modifiable patient-related factors, particularly treatment adherence.