Do Poor Prognostic Factors in Rheumatoid Arthritis Affect Treatment Choices and Outcomes? Analysis of a US Rheumatoid Arthritis Registry
Department of Medicine, Division of Rheumatology
Clinical Epidemiology | Epidemiology | Immune System Diseases | Musculoskeletal Diseases | Rheumatology | Therapeutics
OBJECTIVE: To characterize patients with rheumatoid arthritis (RA) by number of poor prognostic factors (PPF: functional limitation, extraarticular disease, seropositivity, erosions) and evaluate treatment acceleration, clinical outcomes, and work status over 12 months by number of PPF.
METHODS: Using the Corrona RA registry (January 2005-December 2015), biologic-naive patients with diagnosed RA having 12-month (+/- 3 mos) followup were identified and categorized by PPF (0-1, 2, > /= 3). Changes in medication, Clinical Disease Activity Index (CDAI), and work status (baseline-12 mos) were evaluated using linear and logistic regression models.
RESULTS: There were 3458 patients who met the selection criteria: 1489 (43.1%), 1214 (35.1%), and 755 (21.8%) had 0-1, 2, or > /= 3 PPF, respectively. At baseline, patients with > /= 3 PPF were older, and had longer RA duration and higher CDAI versus those with 0-1 PPF. In 0-1, 2, and > /= 3 PPF groups, respectively, 20.9%, 23.2%, and 26.5% of patients received > /= 1 biologic (p = 0.011). Biologic/targeted synthetic disease-modifying antirheumatic drug (tsDMARD) use was similar in patients with/without PPF (p = 0.57). After adjusting for baseline CDAI, mean (standard error) change in CDAI was -4.95 (0.24), -4.53 (0.27), and -2.52 (0.34) for 0-1, 2, and > /= 3 PPF groups, respectively. More patients were working at baseline but not at 12-month followup in 2 (13.9%) and > /= 3 (12.5%) versus 0-1 (7.3%) PPF group.
CONCLUSION: Despite high disease activity and worse clinical outcomes, number of PPF did not significantly predict biologic/tsDMARD use. This may warrant reconsideration of the importance of PPF in treat-to-target approaches.
COHORT STUDIES, PATIENT OUTCOME ASSESSMENT, PROGNOSIS, RHEUMATOID ARTHRITIS
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DOI of Published Version
J Rheumatol. 2018 Oct;45(10):1353-1360. doi: 10.3899/jrheum.171050. Epub 2018 Jul 1. Link to article on publisher's site
The Journal of rheumatology
Alemao, Evo; Litman, Heather J.; Connolly, Sean E.; Kelly, Sheila; Hua, Winnie; Rosenblatt, Lisa; Rebello, Sabrina; Kremer, Joel M.; and Harrold, Leslie R., "Do Poor Prognostic Factors in Rheumatoid Arthritis Affect Treatment Choices and Outcomes? Analysis of a US Rheumatoid Arthritis Registry" (2018). Open Access Articles. 3641.