Poor prognostic factors independently impact remission and treatment escalation in rheumatoid arthritis regardless of disease activity: A nationwide prospective cohort study

You-Jung Ha; Seunghwan Shin; Se Rim Choi; Eun Ha Kang; Yeong Wook Song; Yun Jong Lee

doi:10.1016/j.jbspin.2024.105798

Poor prognostic factors independently impact remission and treatment escalation in rheumatoid arthritis regardless of disease activity: A nationwide prospective cohort study

Joint Bone Spine. 2024 Oct 24;92(1):105798. doi: 10.1016/j.jbspin.2024.105798. Online ahead of print.

Authors

You-Jung Ha¹, Seunghwan Shin², Se Rim Choi¹, Eun Ha Kang¹, Yeong Wook Song³, Yun Jong Lee⁴

Affiliations

¹ Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
² Lunit Inc., 374, Gangnam-daero, Gangnam-gu, Seoul, 06241, Republic of Korea.
³ Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
⁴ Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Medical Device Development, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. Electronic address: yn35@snu.ac.kr.

PMID: 39461412
DOI: 10.1016/j.jbspin.2024.105798

Abstract

Objective: To elucidate the impact of poor prognostic factors (PPFs) in daily practice on achieving remission and the requirement for biologic or targeted synthetic DMARDs (b/tsDMARDs) in a large Korean cohort of patients with rheumatoid arthritis (RA).

Methods: Using the KORean Observational study Network for Arthritis (KORONA) database, patients with RA were categorized into three groups based on the number of PPFs (0-1, 2, or≥3): the presence of functional limitation, extra-articular disease, seropositivity, and bone erosions. Factors related to achieving remission and to initiating b/tsDMARDs were evaluated using Cox proportional hazard regression analyses after adjusting confounders.

Results: Among 5076 patients with RA, group L (PPF≤1), group M (PPFs 2), and group H (PPFs≥3) were 1788 (35.2%), 2027 (39.9%), and 1261 (24.9%), respectively. Group H had higher disease activity and worse patient-reported outcomes than groups L and M. Among moderately-to-highly active patients at baseline, group H was significantly less likely to attain point (hazard ratio [HR]=0.55, 95% confidence interval [CI] 0.38-0.79) and sustained (HR=0.45, 95% CI 0.21-0.99) Boolean-based remission in 5-year. Groups M (HR=1.47, 95% CI 1.10-1.96) and H (HR=1.69, 95% CI 1.22-2.32) had an increased risk of escalation to b/tsDMARDs, compared to group L among b/tsDMARDs-naïve patients at baseline.

Conclusion: Achieving remission was particularly challenging for group H, and more patients in groups M and H initiated b/tsDMARDS during the 5-year observation period. Therefore, the presence of PPFs≥3 significantly influences both patients' outcomes and clinician's treatment decisions regardless of disease activity.

Keywords: Outcome measures; Poor prognostic factors; Rheumatoid arthritis; Targeted therapy.