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A paradigm of difficult-to-treat rheumatoid arthritis: subtypes and early identification


1, 2, 3, 4, 5, 6, 7, 8, 9, 10

 

  1. Rheumatology Department, Hospital Universitario La Paz, Madrid, and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research - IdiPAZ, Madrid, Spain. mnovellanavarro@gmail.com
  2. Rheumatology Department, Hospital Clínic, Barcelona, Spain.
  3. Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain.
  4. Rheumatology Department, Hospital Clínic, Barcelona, Spain.
  5. Rheumatology Department, Hospital Universitario La Paz, Madrid, and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research - IdiPAZ, Madrid, Spain.
  6. Rheumatology Department, Hospital Universitario La Paz, Madrid, and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research - IdiPAZ, Madrid, Spain.
  7. Rheumatology Department, Hospital Universitario La Paz, Madrid, and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research - IdiPAZ, Madrid, Spain.
  8. Rheumatology Department, Hospital Clínic, Barcelona, Spain.
  9. Rheumatology Department, Hospital Universitario La Paz, Madrid, and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research - IdiPAZ, Madrid, Spain.
  10. Rheumatology Department, Hospital Universitario La Paz, Madrid, and Inmuno-Rheumatology Research Group, Hospital La Paz, Institute for Health Research - IdiPAZ, Madrid, Spain.

CER15865
2023 Vol.41, N°5
PI 1114, PF 1119
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PMID: 36377568 [PubMed]

Received: 19/05/2022
Accepted : 12/09/2022
In Press: 13/11/2022
Published: 03/05/2023

Abstract

OBJECTIVES:
Multiple failures to biologic or targeted specific disease-modifying anti-rheumatic drugs (b/tsDMARDs) that lead to difficult-to-treat rheumatoid arthritis (D2TRA) may be the result of multi-drug inefficacy or reflect treatment problems related to adverse events, comorbidities, and/or poor adherence. We aimed to characterise a cohort of D2TRA patients in clinical practice, to analyse the differences between D2TRA due to inefficacy versus D2TRA from other causes, and to compare them with non-D2TRA.
METHODS:
The D2TRA group included patients who were receiving ≥2b/tsDMARDs due to inefficacy (D2TRA-inef cacy) or because of adverse events, poor adherence, contraindications, comorbidities, drug-intolerance, etc. (D2TRA-other). Patients who achieved low disease activity or remission with the rst bDMARD were classified as non-D2TRA patients. For all patients, demographic, clinical characteristics and laboratory parameters were assessed prior to starting the rst b/tsDMARD. Descriptive analysis was performed and bivariate logistic regression models were assembled.
RESULTS:
In total, 253 patients were included: 131 non-D2TRA and 122 D2TRA [86 (70.5%) D2TRA-inefficacy and 36 (29.5%) D2TRA-other]. Comparison of the two groups of D2TRA patients: no differences in gender, age at start of b/tsDMARD or age at RA diagnosis were found; this was also true of socioeconomic status, frequency of anxiety-depression and other comorbidities. Patients categorised as D2TRA-other had less extra-articular manifestations than D2TRA-inef cacy, as well as lower values of DAS28 at the start of the rst b/tsDMARD. Comparisons of Non-D2TRA patients versus D2TRA-other resulted in the following observations: no differences in sociodemographic characteristics were evident nor were there any differences in terms of disease activity.
CONCLUSIONS:
Patients with D2TRA-other are indistinguishable from non-D2TRA patients at baseline, indicating the former cohort does not appear to have any predictive value during the early stages of b/tsDMARD treatment, unlike what occurs in patients with D2TRA-inefficacy.

DOI: https://doi.org/10.55563/clinexprheumatol/7mscci

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