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Abstract Background/Aims Difficult-to-treat rheumatoid arthritis (D2T RA) has a notably higher impact on a patient’s quality of life and is a significant cost and service pressure to the health care provision in comparison to non-D2T RA. The primary aim of this study is to delineate the major contributing factors and characteristics of patients leading to a diagnosis of D2T RA, using the criteria established by the European League Against Rheumatism (EULAR). Methods A retrospective study was conducted within the Rheumatology department in a large district general hospital, with a catchment population of over 700,000 people. A cohort of 722 patients, all of which were on biologic Disease Modifying Anti-Rheumatic Medications (DMARDs) was selected. In this study, we present our findings for the first 95 consecutive patients. Results Of the selected 95 patients, 13% met the EULAR criteria for D2T RA. The key characteristics within this subset include 75% being sero-positive (both Rheumatoid factor and anti-cyclic citrullinated peptide), 66% being categorized as obese, and 42% having concurrent fibromyalgia and osteoarthritis. Among these 13% D2T RA patients, 25% demonstrated a high disease activity index and 75% showed moderate severity. All these patients had been started on at least two conventional DMARDs including methotrexate before escalating to more advanced treatments in line with NICE guidelines. From the subgroup of high disease activity D2T RA patients, 67% had tried at least three types of biologic or targeted synthetic DMARDs (b/ts DMARDs), and 33% had been trialled on four different types of b/ts DMARDs. Similarly, out of the medium severity D2T RA subgroup, 45% had tried three and four DMARDs respectively and 10% had been given five biologic or synthetic DMARDs. Conclusion The major contributing factors leading to D2T RA within this study population appear to be seropositivity for both RF and anti-CCP, obesity, and the presence of comorbidities like fibromyalgia and osteoarthritis. The intertwined relationship between these factors emphasizes the need for a comprehensive and individualized approach to managing patients with D2T RA. Although this cohort is larger than the previous studies, the sample size is relatively small. We aim to look at the remaining 627 patients to identify trends and modifiable risk factors that could help prevent the future development of D2T RA. Disclosure K. Oo: None. M. Memon: None. P. Sharma: None. S. Dahiya: None.
Oo et al. (Mon,) studied this question.