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Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease
OBJECTIVES: Most studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyse whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10008455/ https://www.ncbi.nlm.nih.gov/pubmed/36889800 http://dx.doi.org/10.1136/rmdopen-2022-002842 |
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author | Leon, Leticia Madrid-Garcia, Alfredo Lopez-Viejo, Patricia González-Álvaro, Isidoro Novella-Navarro, Marta Freites Nuñez, Dalifer Rosales, Zulema Fernandez-Gutierrez, Benjamin Abasolo, Lydia |
author_facet | Leon, Leticia Madrid-Garcia, Alfredo Lopez-Viejo, Patricia González-Álvaro, Isidoro Novella-Navarro, Marta Freites Nuñez, Dalifer Rosales, Zulema Fernandez-Gutierrez, Benjamin Abasolo, Lydia |
author_sort | Leon, Leticia |
collection | PubMed |
description | OBJECTIVES: Most studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyse whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analysed. METHODS: A longitudinal multicentre study of patients with RA was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease and management being perceived as problematic by the rheumatologist and/or patient). The main variable was disease activity in the early stages. The covariates were sociodemographic, clinical and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA. RESULTS: The study population comprised 631 patients and 35 (5.87%) developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, 28-joint Disease Activity Score (DAS28) score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.89; p=0.01). CONCLUSIONS: In this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that younger patients and those with elevated initial disability scores are more likely to develop D2T RA regardless of other factors. |
format | Online Article Text |
id | pubmed-10008455 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-100084552023-03-13 Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease Leon, Leticia Madrid-Garcia, Alfredo Lopez-Viejo, Patricia González-Álvaro, Isidoro Novella-Navarro, Marta Freites Nuñez, Dalifer Rosales, Zulema Fernandez-Gutierrez, Benjamin Abasolo, Lydia RMD Open Rheumatoid Arthritis OBJECTIVES: Most studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyse whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analysed. METHODS: A longitudinal multicentre study of patients with RA was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease and management being perceived as problematic by the rheumatologist and/or patient). The main variable was disease activity in the early stages. The covariates were sociodemographic, clinical and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA. RESULTS: The study population comprised 631 patients and 35 (5.87%) developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, 28-joint Disease Activity Score (DAS28) score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.89; p=0.01). CONCLUSIONS: In this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that younger patients and those with elevated initial disability scores are more likely to develop D2T RA regardless of other factors. BMJ Publishing Group 2023-03-08 /pmc/articles/PMC10008455/ /pubmed/36889800 http://dx.doi.org/10.1136/rmdopen-2022-002842 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Rheumatoid Arthritis Leon, Leticia Madrid-Garcia, Alfredo Lopez-Viejo, Patricia González-Álvaro, Isidoro Novella-Navarro, Marta Freites Nuñez, Dalifer Rosales, Zulema Fernandez-Gutierrez, Benjamin Abasolo, Lydia Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease |
title | Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease |
title_full | Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease |
title_fullStr | Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease |
title_full_unstemmed | Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease |
title_short | Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease |
title_sort | difficult-to-treat rheumatoid arthritis (d2t ra): clinical issues at early stages of disease |
topic | Rheumatoid Arthritis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10008455/ https://www.ncbi.nlm.nih.gov/pubmed/36889800 http://dx.doi.org/10.1136/rmdopen-2022-002842 |
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