Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

AbstractObjectivesMost studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyze whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analyzed.MethodsA longitudinal multicenter study of RA patients was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease, and management being perceived as problematic by the rheumatologist and/or patient). The main outcome was disease activity in the early stages. The covariates were sociodemographic, clinical, and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA. Weighting techniques were also applied to balance data.ResultsThe study population comprised 631 patients and 35 developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, DAS28 score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.50; p=0.02).ConclusionsIn this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that patients with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.What is already known on this topicDespite T2T and the availability of a range of advanced therapies, D2T RA remains a relevant clinical problem. Evidence for the D2T RA population have focused on established RA. The aim of our study was to analyze whether disease activity at diagnosis could influence progression to D2T RA under real-life conditions.What this study addsWe did find that patients with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.How this study might affect research, practice or policyThe implementation of more effective strategies in the early stages of the disease and focused on the most influential factors, including severe disability, may change disease course and prevent D2T RA.