Poor prognostic factors independently impact remission and treatment escalation in rheumatoid arthritis regardless of disease activity: A nationwide prospective cohort study - 23/01/25
Graphical abstract |
Highlights |
• | Patients with rheumatoid arthritis (RA) and more ACR-defined poor prognostic factors (PPFs) had higher disease activity and poorer patients’ reported outcomes. |
• | RA patients with≥3 PPFs were less likely to achieve remission during the 5-year follow-up period, regardless of disease activity. |
• | RA patients with a higher number of PPFs were significantly associated with a greater likelihood of initiating biologic or targeted synthetic disease-modifying anti-rheumatic drugs. |
• | Considering that the ACR-defined PPFs affect both patients’ long-term outcomes and clinician's decisions, the number of PPF should be integrated into the ‘treat-to-target strategy’ for RA. |
Abstract |
Objective |
To elucidate the impact of poor prognostic factors (PPFs) in daily practice on achieving remission and the requirement for biologic or targeted synthetic DMARDs (b/tsDMARDs) in a large Korean cohort of patients with rheumatoid arthritis (RA).
Methods |
Using the KORean Observational study Network for Arthritis (KORONA) database, patients with RA were categorized into three groups based on the number of PPFs (0–1, 2, or≥3): the presence of functional limitation, extra-articular disease, seropositivity, and bone erosions. Factors related to achieving remission and to initiating b/tsDMARDs were evaluated using Cox proportional hazard regression analyses after adjusting confounders.
Results |
Among 5076 patients with RA, group L (PPF≤1), group M (PPFs 2), and group H (PPFs≥3) were 1788 (35.2%), 2027 (39.9%), and 1261 (24.9%), respectively. Group H had higher disease activity and worse patient-reported outcomes than groups L and M. Among moderately-to-highly active patients at baseline, group H was significantly less likely to attain point (hazard ratio [HR]=0.55, 95% confidence interval [CI] 0.38–0.79) and sustained (HR=0.45, 95% CI 0.21–0.99) Boolean-based remission in 5-year. Groups M (HR=1.47, 95% CI 1.10–1.96) and H (HR=1.69, 95% CI 1.22–2.32) had an increased risk of escalation to b/tsDMARDs, compared to group L among b/tsDMARDs-naïve patients at baseline.
Conclusion |
Achieving remission was particularly challenging for group H, and more patients in groups M and H initiated b/tsDMARDS during the 5-year observation period. Therefore, the presence of PPFs≥3 significantly influences both patients’ outcomes and clinician's treatment decisions regardless of disease activity.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Rheumatoid arthritis, Poor prognostic factors, Outcome measures, Targeted therapy
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Vol 92 - N° 1
Articolo 105798- gennaio 2025 Ritorno al numero
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