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Patient and physician assessment in difficult-to-treat rheumatoid arthritis: patterns of subjective perception at early stages of b/tsDMARD treatment

OBJECTIVES: To analyse the trajectories of Disease Activity Score 28 (DAS28), patient global assessment (PGA) and physician global assessment (PhGA) and to assess their predictive capabilities on difficult-to-treat rheumatoid arthritis (D2TRA) classification. METHODS: Longitudinal study of patients...

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Autores principales: Novella -Navarro, Marta, Cabrera-Alarcón, JoséLuis, López-Juanes, Natalia, Villalba, Alejandro, Fernández Fernández, Elisa, Monjo, Irene, Peiteado, Diana, Nuño, Laura, Plasencia-Rodríguez, Chamaida, Balsa, Alejandro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546133/
https://www.ncbi.nlm.nih.gov/pubmed/37775112
http://dx.doi.org/10.1136/rmdopen-2023-003382
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author Novella -Navarro, Marta
Cabrera-Alarcón, JoséLuis
López-Juanes, Natalia
Villalba, Alejandro
Fernández Fernández, Elisa
Monjo, Irene
Peiteado, Diana
Nuño, Laura
Plasencia-Rodríguez, Chamaida
Balsa, Alejandro
author_facet Novella -Navarro, Marta
Cabrera-Alarcón, JoséLuis
López-Juanes, Natalia
Villalba, Alejandro
Fernández Fernández, Elisa
Monjo, Irene
Peiteado, Diana
Nuño, Laura
Plasencia-Rodríguez, Chamaida
Balsa, Alejandro
author_sort Novella -Navarro, Marta
collection PubMed
description OBJECTIVES: To analyse the trajectories of Disease Activity Score 28 (DAS28), patient global assessment (PGA) and physician global assessment (PhGA) and to assess their predictive capabilities on difficult-to-treat rheumatoid arthritis (D2TRA) classification. METHODS: Longitudinal study of patients with rheumatoid arthritis (RA) from 2020 to 2022. Based on the D2TRA EULAR (European Alliance of Associations for Rheumatology) definition, patients were classified as D2TRA according to biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) failure due to inefficacy (D2TRA-inefficacy) or other reasons (D2TRA-other). Patients who did not fulfil the D2TRA criteria were classified as NoD2TRA. DAS28, PGA and PhGA scores collected every 6 months during the first 24 months of b/tsDMARD treatment were used to identify different trajectories using latent class mixed models (LCMM). RESULTS: The study population comprised 255 patients with RA, of whom 167 were NoD2TRA, 58 D2TRA-inefficacy and 30 D2TRA-other. LCMM stratified patients into two different trajectories for DAS28 and PhGA and three for PGA according to the most stable model. The most notable variation occurred during the first 6 months of treatment, thereafter remaining stable during the follow-up period. Most D2TRA-inefficacy patients fitted the trajectory, showing higher values of the studied parameters. NoD2TRA followed the trajectory with lower values, and D2TRA-other were distributed more homogeneously across all trajectories. CONCLUSIONS: The assessment of disease activity, together with patients’ and physicians’ perceptions, form a key element in the correct discrimination of patients who are going to develop D2TRA-inefficacy. However, identifying those patients who will be D2TRA-other remains challenging, whether by subjective or objective parameters.
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spelling pubmed-105461332023-10-04 Patient and physician assessment in difficult-to-treat rheumatoid arthritis: patterns of subjective perception at early stages of b/tsDMARD treatment Novella -Navarro, Marta Cabrera-Alarcón, JoséLuis López-Juanes, Natalia Villalba, Alejandro Fernández Fernández, Elisa Monjo, Irene Peiteado, Diana Nuño, Laura Plasencia-Rodríguez, Chamaida Balsa, Alejandro RMD Open Rheumatoid Arthritis OBJECTIVES: To analyse the trajectories of Disease Activity Score 28 (DAS28), patient global assessment (PGA) and physician global assessment (PhGA) and to assess their predictive capabilities on difficult-to-treat rheumatoid arthritis (D2TRA) classification. METHODS: Longitudinal study of patients with rheumatoid arthritis (RA) from 2020 to 2022. Based on the D2TRA EULAR (European Alliance of Associations for Rheumatology) definition, patients were classified as D2TRA according to biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) failure due to inefficacy (D2TRA-inefficacy) or other reasons (D2TRA-other). Patients who did not fulfil the D2TRA criteria were classified as NoD2TRA. DAS28, PGA and PhGA scores collected every 6 months during the first 24 months of b/tsDMARD treatment were used to identify different trajectories using latent class mixed models (LCMM). RESULTS: The study population comprised 255 patients with RA, of whom 167 were NoD2TRA, 58 D2TRA-inefficacy and 30 D2TRA-other. LCMM stratified patients into two different trajectories for DAS28 and PhGA and three for PGA according to the most stable model. The most notable variation occurred during the first 6 months of treatment, thereafter remaining stable during the follow-up period. Most D2TRA-inefficacy patients fitted the trajectory, showing higher values of the studied parameters. NoD2TRA followed the trajectory with lower values, and D2TRA-other were distributed more homogeneously across all trajectories. CONCLUSIONS: The assessment of disease activity, together with patients’ and physicians’ perceptions, form a key element in the correct discrimination of patients who are going to develop D2TRA-inefficacy. However, identifying those patients who will be D2TRA-other remains challenging, whether by subjective or objective parameters. BMJ Publishing Group 2023-09-28 /pmc/articles/PMC10546133/ /pubmed/37775112 http://dx.doi.org/10.1136/rmdopen-2023-003382 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
Novella -Navarro, Marta
Cabrera-Alarcón, JoséLuis
López-Juanes, Natalia
Villalba, Alejandro
Fernández Fernández, Elisa
Monjo, Irene
Peiteado, Diana
Nuño, Laura
Plasencia-Rodríguez, Chamaida
Balsa, Alejandro
Patient and physician assessment in difficult-to-treat rheumatoid arthritis: patterns of subjective perception at early stages of b/tsDMARD treatment
title Patient and physician assessment in difficult-to-treat rheumatoid arthritis: patterns of subjective perception at early stages of b/tsDMARD treatment
title_full Patient and physician assessment in difficult-to-treat rheumatoid arthritis: patterns of subjective perception at early stages of b/tsDMARD treatment
title_fullStr Patient and physician assessment in difficult-to-treat rheumatoid arthritis: patterns of subjective perception at early stages of b/tsDMARD treatment
title_full_unstemmed Patient and physician assessment in difficult-to-treat rheumatoid arthritis: patterns of subjective perception at early stages of b/tsDMARD treatment
title_short Patient and physician assessment in difficult-to-treat rheumatoid arthritis: patterns of subjective perception at early stages of b/tsDMARD treatment
title_sort patient and physician assessment in difficult-to-treat rheumatoid arthritis: patterns of subjective perception at early stages of b/tsdmard treatment
topic Rheumatoid Arthritis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546133/
https://www.ncbi.nlm.nih.gov/pubmed/37775112
http://dx.doi.org/10.1136/rmdopen-2023-003382
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