Poly‐Refractory Rheumatoid Arthritis: An Uncommon Subset of Difficult to Treat Disease With Distinct Inflammatory and Noninflammatory Phenotypes
Authors' conclusion
Only 2.7% of D2T-RA failed all classes of b/tsDMARDs. Among D2T-RA, less than 60% had objective signs of inflammation, representing a target for innovative strategies.
Study context
- Population
- Patients with rheumatoid arthritis (RA) on b/tsDMARDs1,469 analysed
- Participants
- 1,591 patients
- Exposure
- Poly-refractory RA vs other difficult-to-treat RA (D2T-RA); PIRRA vs noninflammatory refractory RA (NIRRA)
- Poly-refractory RAn = 40
- PIRRAn = 61
- NIRRAn = 46
- Outcome
- Prevalence of poly-refractory RA (failure of all b/tsDMARDs)
Methodological detailsmultivariate logistic regression
- Multivariate logistic regression
Main finding
As reported in the abstract
Prevalence
Poly-refractory RA
2.7%
40
- D2T-RA
- 247 of 1,469 (16.8%)
Observational data: associations, not effects.
Further findings
Smoking associated with poly-refractory RA
| OR (95% CI) | P value | ||
|---|---|---|---|
| Smoking | 5.067 (1.774–14.472) | P = 0.002 | |
| 0.050.21520Odds ratio (log scale) |
| Outcome | Poly-refractory RA | Other D2T | PIRRA | NIRRA | P value |
|---|---|---|---|---|---|
| DAS28-CRP, poly-refractory vs other D2TMedian | 5.4 | 5.02 | — not stated in the abstract | — not stated in the abstract | P < 0.05 |
| CRP, poly-refractory vs other D2TMedian, mg/l | 13 | 5 | — not stated in the abstract | — not stated in the abstract | P < 0.01 |
| Smoking (ever), poly-refractory vs other D2T | 20% | 4% | — not stated in the abstract | — not stated in the abstract | P < 0.01 |
| PIRRA vs NIRRA among D2T-RA with recent US | — not stated in the abstract | — not stated in the abstract | 57% | 43% | |
| BMI, NIRRA vs PIRRAMedian | — not stated in the abstract | — not stated in the abstract | 26 | 30 | P < 0.001 |
| FM prevalence, NIRRA vs PIRRA | — not stated in the abstract | — not stated in the abstract | 3% | 15% | P < 0.05 |
| Swollen joint count, NIRRA vs PIRRAMedian | — not stated in the abstract | — not stated in the abstract | 5 | 2 | P < 0.001 |
| CRP, NIRRA vs PIRRA | — not stated in the abstract | — not stated in the abstract | 10 | 5 | P < 0.01 |
— not stated in the abstract
- PIRRA vs NIRRA among D2T-RA with recent ultrasound (US): 107 D2T-RA with recent US
Original publication
Poly‐Refractory Rheumatoid Arthritis: An Uncommon Subset of Difficult to Treat Disease With Distinct Inflammatory and Noninflammatory Phenotypes. Arthritis Rheumatol. Published 6 February 2024. doi:10.
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