Chinese Registry of Rheumatoid Arthritis (CREDIT) VI: Temporal Trends in Patients With Early Rheumatoid Arthritis and Moderate-To-Severe Disease Activity - A Multicenter Cohort Study of Treatment Strategies and Outcomes

Int J Rheum Dis. 2025 Jan;28(1):e70066. doi: 10.1111/1756-185X.70066.

Abstract

Aim: The continuous update of international guidelines and enhanced availability of biological disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) have made a significant impact on the diagnosis and treatment of early rheumatoid arthritis (ERA). This study aims to systematically evaluate the current treatment strategies and outcomes within a large-scale cohort of patients with ERA.

Methods: Data from the Chinese Registry of Rheumatoid Arthritis (CREDIT), a large multicenter Chinese registry of RA, were collected to analyze temporal trends in clinical profiles, therapeutic strategies, and treatment outcomes among patients with ERA.

Results: From November 2016 to October 2023, A total of 2722 patients with follow-up information for 6 months were included. The use of methotrexate (MTX) increased annually and has become the predominant DMARD as the initial treatment. Following initial therapy, 1059 (38.9%) patients achieved the therapeutic target of low disease activity and remission. Age ≥ 50 years (adjusted OR 0.70 [95% CI 0.59-0.83]; p < 0.001), high baseline disease activity (adjusted OR 0.48 [95% CI 0.41-0.57]; p < 0.001), csDMARD monotherapy other than MTX (adjusted OR 0.55 [95% CI 0.41-0.73]; p < 0.001), and the use of b/tsDMARDs without a csDMARD combination (adjusted OR 0.57 [95% CI 0.36-0.87]; p = 0.011) were associated with lower target attainment rates. For patients who did not achieve the treatment target after initial therapy, the use of b/tsDMARDs increased after 2020, although the extent of therapeutic escalation remained suboptimal.

Conclusion: Treatment of patients with ERA in China has become more standardized. Adherence to guideline-directed therapeutic regimens has emerged as a significant determinant of therapeutic target achievement. The increased prevalence of b/tsDMARDs would benefit more patients in ameliorating the disease.

Keywords: rheumatoid arthritis; temporal trends; treatment standardization; treat‐to‐target.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Antirheumatic Agents* / therapeutic use
  • Arthritis, Rheumatoid* / diagnosis
  • Arthritis, Rheumatoid* / drug therapy
  • Arthritis, Rheumatoid* / epidemiology
  • China / epidemiology
  • Drug Therapy, Combination
  • East Asian People
  • Female
  • Humans
  • Male
  • Methotrexate / therapeutic use
  • Middle Aged
  • Registries*
  • Remission Induction*
  • Severity of Illness Index*
  • Time Factors
  • Treatment Outcome

Substances

  • Antirheumatic Agents
  • Methotrexate