In patients with rheumatoid arthritis (RA) starting methotrexate for the first time, several demographic, clinical, and psychosocial factors predict nonresponse, according to study results published in Arthritis Research and Therapy. Factors include rheumatoid factor negativity, higher Health Assessment Questionnaire (HAQ) score, higher tender joint count, lower Disease Activity score in 28 joints (DAS28), and higher Hospital and Anxiety and Depression Scale anxiety score.

The study included participants recruited to the Rheumatoid Arthritis Medication Study who were starting methotrexate for the first time. The researchers defined nonresponse to methotrexate at 6 months as “no response” using the European League Against Rheumatism (EULAR) response criteria, discontinuation of methotrexate due to inefficacy, or starting biologic therapy. They assessed the association of baseline demographic, clinical, and psychosocial predictors with nonresponse using logistic regression.

Of 1050 participants, 43% (n=449) met the classification for nonresponders.

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The researchers found several independent multivariable predictors of nonresponse to methotrexate, including rheumatoid factor negativity (odds ratio [OR], 0.62; 95% CI, 0.45-0.86), higher HAQ scores (OR, 1.64; 95% CI, 1.25-2.15), higher tender joint count (OR, 1.06; 95% CI, 1.02-1.10), lower DAS28 scores (OR, 0.29; 95% CI, 0.23-0.39), and higher Hospital and Anxiety and Depression Scale anxiety scores (OR, 1.07; 95% CI, 1.03-1.12).

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The researchers noted that because patient anxiety was linked to non-response, this factor could be addressed by clinicians at treatment commencement.

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Sergeant JC, Hyrich KL, Anderson J, et al. Prediction of primary non-response to methotrexate therapy using demographic, clinical and psychosocial variables: results from the UK Rheumatoid Arthritis Medication Study (RAMS) [published online July 13, 2018]. Arthritis Res Ther. doi:10.1186/s13075-018-1645-5