Clinical characteristics of patients with rheumatoid arthritis in pre-difficult-to-treat status

Abstract

Objectives: The aim of this study was to identify risk factors for failure and find preventive measures in patients with pre-difficult-to-treat rheumatoid arthritis（pre-D2T RA）.

Methods: RA patients who received a treat-to-target treatment strategy were selected. D2T RA status was determined according to the EULAR definition of D2T RA, and pre-D2T RA status was determined as follows: Category-1（administration of a second drug with a different effect due to failure of one biologic or JAK inhibitor）and -2（Moderate disease activity, glucocorticoid dose greater than 7.5 mg prednisolone equivalent, rapid radiographic progression, or quality of life score reduced in 6 months） were defined, and the first time a match was made during treatment was taken as baseline. Results were determined at final observation at more than 1 year. When patients left each category, they were judged as “success” or “failure” if they continued. Risk factors for “failure” in the patient context and observation items in the treatment were assessed by category. Patients who met Category 2 were also selected as the target group, and risk factors were examined.

Results: A total of 47 in pre-D2T RA and 444 patients in control group were recruited. In pre-D2T RA patients, significant risk factor was higher simplified disease activity index（SDAI）score and prescription of a new glucocorticoid formulation（GCS）during treatment（p<0.05）. In the control group, significant risk factors were non-prescription of methotrexate throughout the treatment period and disease control including SDAI during follow-up.

Conclusions: The most important factor for prevention of D2T RA was strict disease activity control. GCS prescription in pre-D2T RA should be avoided.