Background/Purpose: Despite significant research on rheumatoid arthritis (RA), disease courses have not been clearly described. Like systemic lupus erythematosus and multiple sclerosis, RA displays a diversity of disease patterns across patients. The purpose of this study was to describe the range of RA disease courses and how they relate to rheumatology treatment including time to diagnosis and degree of improvement with DMARDs.

Methods: An anonymous, web-based questionnaire was developed, pilot-tested and presented over 7 days in 2019 on a secure survey system preventing multiple entries. Eligible participants were U.S. residents age ≥18 years with a self-reported diagnosis of RA by a medical professional. Participants recruited by email and social media answered closed and open-ended questions about socio-demographics, their RA disease activity, diagnosis and DMARD history, and improvement from RA treatment. Patients were also asked which of a list of disease patterns best described their RA: “I have constant symptoms that don’t change”; “I have constant symptoms that get worse over time”; “I have no disease symptoms”; “Symptoms come and go, and get worse over time”; and “Symptoms come and go, but don’t get worse over time”. These patterns were categorized in 2 dimensions: (1) constant vs flaring and remitting and (2) progressive vs non-progressive.

Results: 907 people responded (90% women, 10% men), with a mean age of 58 years and 11.1 years since diagnosis (SD 10.1). Patients were asked which of a list of disease patterns best described their RA. The responses as listed above were 15%, 30%, 2%, 29%, and 24%, respectively (Fig 1).

Of respondents who reported a flaring and remitting pattern, 50% reached ≥ 70% improvement from treatment while only 20% of respondents reporting constant disease reached ≥ 70% improvement (Fig 2). Furthermore, 49% of respondents with a non-progressive disease course reached ≥ 70% improvement, while conversely 28% of those with a progressive disease course reached ≥ 70% improvement.

Only 5% of respondents reporting constant progressive symptoms were diagnosed within 3 months of symptom onset. Respondents with this disease pattern were more likely to have had symptoms >10 years before diagnosis compared to other patterns. Those having >10 years between first symptoms and diagnosis were more likely to have progressive disease than non-progressive disease. Thirty-six percent of those who experienced symptoms ≥5 years before diagnosis considered their disease constant and progressive (Table 1). Respondents were 95% more likely to achieve ≥70% improvement if diagnosed within a year of symptom onset versus ≥5 years after symptom onset.

Conclusion: RA patients experience a variety of disease patterns not readily reflected in literature describing RA disease activity. Disease courses may be related to time to diagnosis and treatment and also may impact levels of improvement from RA treatment. While RA is a heterogeneous disease, recognizing patterns of the disease may assist both research and treatment decisions. Further research should explore more thoroughly how RA disease patterns affect rheumatology treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ra-presents-in-disease-patterns-impacting-treatment-response/