Poor Prognostic Factors in Rheumatoid Arthritis May Not Affect Treatment Choices, Outcomes

In patients with rheumatoid arthritis (RA), a greater number of poor prognostic factors (PPFs) is not associated with a greater likelihood of biologic or targeted synthetic disease-modifying antirheumatic drug (tsDMARD) initiation or with any treatment acceleration, according to an analysis of findings from the Corrona RA Registry published in The Journal of Rheumatology.

Biologic-naive patients with RA and 12-month follow-up were identified between January 2005 and December 2015 from the Corrona RA Registry and were categorized based on the number of PPFs (0 to 1, 2, or ≥3). Linear and logistic regression models were used to evaluate Clinical Disease Activity Index (CDAI), changes in medication, and work status.

A total of 3458 patients met the selection criteria. Overall, 43.1% had 0 to 1 PPF, 35.1% had 2 PPFs, and 21.8% had ≥3 PPFs. At baseline, participants with ≥3 PPFs were older, had longer RA duration, and had higher CDAI scores compared with participants with 0 to 1 PPF. In the groups with 0 to 1 PPF, 2 PPFs, and ≥3 PPFs, 20.9%, 23.2%, and 26.5% of patients, respectively, received ≥1 biologic agent (P =.011).

The use of biologics and tsDMARDs was similar in patients with and without PPFs (P =.057). After adjustment for baseline CDAI, the mean change in CDAI was −4.95±0.24, −4.53±0.27, and −2.52±0.34 in the groups with 0 to 1 PPF, 2 PPFs, and ≥3 PPFs, respectively. Moreover, there were more patients who were working at baseline but not at the 12-month follow-up in the 2 PPFs group (13.9%) and the ≥3 PPFs group (12.5%) vs the 0 to 1 PPF group (7.3%).

The investigators concluded that despite reports of high disease activity and worse clinical outcomes, the number of PPFs did not significantly predict the use of biologic agents or tsDMARDs in patients with RA. Reconsideration of the importance of PPFs in treat-to-target approaches in patients with RA is warranted.

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Reference

Alemao E, Litman HJ, Connolly SE, et al. Do poor prognostic factors in rheumatoid arthritis affect treatment choices and outcomes? Analysis of a US Rheumatoid Arthritis Registry [published online July 1, 2018]. J Rheumatol. doi:10.3899/jrheum.171050