Early characterization of difficult-to-treat rheumatoid arthritis by suboptimal initial management: a multicentre cohort study
Authors' conclusion
Failure to start methotrexate within 3 months and not being off glucocorticoids within 6 months are early predictive features of D2T-RA.
Study context
- Population
- Individuals fulfilling the 2010 ACR/EULAR RA criteria diagnosed 2000–2019; enrolled 09/2021–03/2022
- Participants
- 48 vs 145
- Exposure
- Difficult-to-treat RA (D2T-RA) vs non-D2T-RA: early treatment optimization
- D2T-RAn = 48
- Non-D2T-RAn = 145reference
- Outcome
- D2T-RA by the EULAR definition
Methodological detailsmulticentre, robust regression, multinomial regression, sensitivity case-control analysis matched on year of diagnosis
- Multicentre
- Robust regression
- Multinomial regression
- Sensitivity case-control analysis matched on year of diagnosis
Main finding
As reported in the abstract
Associations with D2T-RA (multiple regression)
Treatment delay beyond 3 months, OR
0.3
95% CI 0.1, 0.9
Non-discontinuation of GC after 6 months, OR
4.6
95% CI 2.2, 9.5
Observational data: associations, not effects.
Further findings
MTX started within 3 months
P = 0.011
Adequate duration of MTX
GC continued beyond 6 months
P < 0.001
Adequate duration of MTX
- Significantly fewer D2T-RA patients
Associations with persistent inflammatory refractory RA (PIRRA) and non-inflammatory refractory RA (NIRRA) (multinomial regression)
- Treatment delay significantly associated with PIRRA only
- Non-discontinuation of GC significantly associated with PIRRA and NIRRA
Original publication
Early characterization of difficult-to-treat rheumatoid arthritis by suboptimal initial management: a multicentre cohort study. Rheumatology (Oxford). Published 3 October 2022. doi:10.
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