Early characterization of difficult-to-treat rheumatoid arthritis by suboptimal initial management: a multicentre cohort study

• Published in: Rheumatology (Oxford, England) England), 2023-06, Vol.62 (6), p.2083-2089
• Main Authors: Giollo, Alessandro, Zen, Margherita, Larosa, Maddalena, Astorri, Davide, Salvato, Mariangela, Calligaro, Antonia, Botsios, Konstantinos, Bernardi, Cristina, Bianchi, Gerolamo, Doria, Andrea
• Format: Article
• Language: English
• Subjects: Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; Case-Control Studies; Cohort Studies; Glucocorticoids - therapeutic use; Humans; Methotrexate - therapeutic use; Treatment Outcome
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/keac563

To demonstrate that unsuccessful treatment optimization in early disease is associated with difficult-to-treat RA (D2T-RA). In this retrospective multicentre cohort study conducted from 09/2021-03/2022, we enrolled individuals fulfilling the 2010 ACR/EULAR RA criteria diagnosed 2000-2019. The outcome was D2T-RA by the EULAR definition. We used robust regression to examine the associations with delay, dose, duration of methotrexate and discontinuation of glucocorticoids. We tested through multinomial regression which factors were associated with persistent inflammatory refractory RA (PIRRA) or non-inflammatory refractory RA (NIRRA). Sensitivity analysis included a case-control study matching the year of diagnosis. We enrolled 48 D2T-RA patients and 145 non-D2T-RA controls. Methotrexate was started within 3 months in 16.7% of D2T-RA vs 33.1% of non-D2T-RA (P = 0.011). Adequate duration of methotrexate was obtained in significantly fewer D2T-RA patients (70.8% vs 85.5%). Glucocorticoids were continued beyond 6 months in a higher proportion of D2T-RA patients (70.8% vs 33.8%, P