Prevalence and predictive factors of difficult-to-treat rheumatoid arthritis: the KURAMA cohort

• Main Authors: Ryu Watanabe, Motomu Hashimoto, Koichi Murata, Kosaku Murakami, Masao Tanaka, Koichiro Ohmura, Hiromu Ito, Shuichi Matsuda
• Format: Article
• Language: English
• Published: Taylor & Francis Group 2021-05-01
• Series: Immunological Medicine
• Subjects: difficult-to-treat rheumatoid arthritis; disease activity; pulmonary involvement; rheumatoid arthritis; rheumatoid factor
• Online Access: http://dx.doi.org/10.1080/25785826.2021.1928383

Difficult-to-treat rheumatoid arthritis (D2T RA) is a multifactorial condition in which disease activity of RA persists despite consecutive treatment with biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). To evaluate the prevalence and predictive risk factors of D2T RA in our institution, a single-center, retrospective study was conducted. Medical records of RA patients, who visited our hospital from 2011 to 2020 and had a follow-up of more than 6 months, were retrospectively reviewed. D2T RA was defined as RA with a disease activity score of 28 – erythrocyte sedimentation rate (DAS28-ESR) of 3.2 or higher at the last visit, despite the use of at least two b/tsDMARDs. A logistic regression model was used to identify risk factors. A total of 672 patients were enrolled. The mean age at disease onset was 52.1 years and females were dominant (76.3%). After a mean follow-up of 46.6 months, patients with D2T RA accounted for 7.9% of overall patients. Multivariate analysis identified high rheumatoid factor (RF) levels (≥156.4 IU/mL, odds ratio [OR]: 1.95), DAS28-ESR (OR: 1.24), and coexisting pulmonary disease (OR: 2.03) as predictive risk factors of D2T RA. In conclusion, high RF levels, high DAS28-ESR, and coexisting pulmonary disease at baseline can predict the development of D2T RA.