Heterogeneity Within a “difficult to Treat” Rheumatoid Arthritis Patients Cohort: 36% May Have a More Benign Course and Have Distinct Characteristics at bDMARD or tsDMARD Initiation

Irini Flouri¹, Antonios Bertsias², Argyro Repa², Nestor Avgoustidis², Eleni Kalogiannaki², Sofia Pitsigavdaki³, George Bertsias⁴ and Prodromos Sidiropoulos⁴, ¹University of Crete Medical School, Heraklion, Greece, ²Rheumatology, Clinical Immunology and Allergy Department, Medical School, University of Crete, Heraklion, Greece, ³Rheumatology, Clinical Immunology and Allergy Department, Medical School, University of Crete, Crete, Greece, ⁴Rheumatology, Clinical Immunology and Allergy Department, Medical School, University of Crete, Greece; Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology Hellas (FORTH), Heraklion, Greece

Meeting: ACR Convergence 2023

Keywords: biologic response modifiers, Cohort Study, Outcome measures, prognostic factors, rheumatoid arthritis

Session Information

Date: Sunday, November 12, 2023

Title: (0380–0422) RA – Diagnosis, Manifestations, and Outcomes Poster I

Session Type: Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Early detection of difficult to treat (D2T) RA patients as well as better characterization of their long-term course represent unresolved issues. Herein we aimed for a detailed analysis of predictors and assessed for heterogeneity of long-term prognosis within D2T patients.

Methods: This was an analysis from “University of Crete Rheumatology Clinic Registry (UCRCR)”, a prospective single center study. We analyzed all patients included form May 2000 until April 2022 and applied the EULAR definition of D2T. Univariate and multivariate analysis of sociodemographic and RA-related characteristics at start of first bDMARDs or tsDMARD were analysed as predictors of D2T. Heterogeneity (HAQ and DAS28 trajectories) withing D2T group was analysed during a follow-up period of 60 months applying latent class trajectory analysis.

Results: 251 out of 1264 patients (19.9%) identified as D2T. Female gender, age at 1^st biologic, RF negative, higher RDCI scores, Sicca symptoms, disease duration, higher DAS28 and HAQ at baseline and failure to decrease DAS28 >1.2 at 6 months were all associated with D2T grouping (p < 0.05). Patients classified as D2T suffered from osteoarthritis, fibromyalgia, dyslipidemia, hypothyroidism and obesity at significantly higher rates compared to non-D2T patients (p < 0.05 for all). Latent class trajectory analysis during 60 months of follow-up, indicated that D2T patients do not constitute a homogenous group; interestingly distinct disease activity trajectory groups could be differentiated while ~36% of them showed a more favorable outcome but never reaching low disease activity (DAS 28 ESR~ 3.8 at 60 months) (Figure 1).

Conclusion: D2T patients represent a heterogenous group of RA patients in terms of long-term disease course. Age, comorbidities, inflammatory burden and compromised function at start of bDMARD/tsDMARD may characterize D2T group.

Table. Univariate comparisons of selected factors between D2T and non-D2T patients

Figure – Latent class trajectory analysis of DAS28-esr over time

Disclosures: I. Flouri: None; A. Bertsias: None; A. Repa: None; N. Avgoustidis: None; E. Kalogiannaki: None; S. Pitsigavdaki: None; G. Bertsias: None; P. Sidiropoulos: None.

To cite this abstract in AMA style:

Flouri I, Bertsias A, Repa A, Avgoustidis N, Kalogiannaki E, Pitsigavdaki S, Bertsias G, Sidiropoulos P. Heterogeneity Within a “difficult to Treat” Rheumatoid Arthritis Patients Cohort: 36% May Have a More Benign Course and Have Distinct Characteristics at bDMARD or tsDMARD Initiation [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/heterogeneity-within-a-difficult-to-treat-rheumatoid-arthritis-patients-cohort-36-may-have-a-more-benign-course-and-have-distinct-characteristics-at-bdmard-or-tsdmard-initiation/. Accessed .

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