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Background: In the treatment of rheumatoid arthritis (RA), advances in drugs have made it possible to control the progression of joint destruction, causing less physical dysfunction. Since RA is a cause of frailty, it causes a decline in quality of life. Therefore, it is important to treat RA according to the Treat to Target proposed. However, the condition may become difficult-to-treat RA (D2T RA) even with the use of several drugs. In the context of Criterion #2 in the EULAR-defined D2TRA, 'characterisation of active/symptomatic disease, "the phrase 'Well-controlled disease according to above standards, but still having RA symptoms that are causing a reduction in quality of life" is included without a clear definition. Objectives: The aim of this study was to identify the indicators that cause a "reduction in quality of life". Methods: Data for this study were obtained from a multicenter observational study (T-FLAG study) involving patients at three institutions. Of 696 RA patients enrolled in the study in 2023, 678 patients with evaluable D2T RA were included. From previous reports (1), we defined D2T RA as disease activity DAS28 ≥3.2 despite the use of at least two b/ts DMARDs. HAQ-DI was used to assess physical function, the Kihon Checklist (KCL) was used to assess frailty, and SARC-F was used to assess sarcopenia. Total KCL scores range from 0 to 25 points, with 8, 4-7, and 0-3 points defining 'frailty,' 'pre-frailty,' and 'robust,' respectively. Multivariable logistic analysis was performed to explore factors associated with D2T RA. Cutoff values were calculated using ROC curves for factors associated with D2T RA. Results: Thirty-eight patients (5.6%) were identified as D2T RA. D2T RA versus Non-D2T RA showed significant differences in female, disease duration, seropositivity, DAS28, HAQ-DI, KCL, and SARC-F, while no significant differences were observed in age and glucocorticoid dose (Table 1). Multivariable analysis in each model showed that KCL (OR: 1.09, 95% CI: 1.01-1.18) was an associated factor with D2T RA, independent of disease activity and glucocorticoid dose, but HAQ-DI (OR: 1.21, 95% CI: 0.73-2.01), SARC-F (OR: 1.08, 95% CI: 0.91-1.27) were not associated factors (Table 2). The cutoff value of KCL for D2T RA was 7 (sensitivity 88.9%, specificity 53.6%, AUC 0.717). Conclusion: KCL, a frailty measure, was found to be an associated factor with D2T RA, independent of disease activity and glucocorticoid dose in D2T RA Criterion #2: characterisation of active/symptomatic disease. REFERENCES: 1 Watanabe R, Hashimoto M, Murata K, et al. Prevalence and predictive factors of difficult-to-treat rheumatoid arthritis: the KURAMA cohort. Immunol Med. 2022;45(1):35-44. Acknowledgements: We thank Ms Sachiko Kato, Ms Emi Yokota, Ms Ritsuko Otakeand Ms Takako Sashikata for their assistance with informationcollection. Disclosure of Interests: None declared.
Suzuki et al. (Sat,) studied this question.