Abstract Background/Aims Treatment advances in rheumatoid arthritis (RA) have led to earlier and better control of disease activity in the biologic era. However, difficult-to-treat (D2T) RA remains a significant challenge. The EULAR 2021 definition focuses on persistently active disease despite adequate treatment with multiple biologics. Identifying the predictors of D2T RA is crucial for developing personalised strategies to improve patient outcomes. We undertook this audit at a single centre in the UK to determine the predictors of D2T RA and to ascertain the current management practice. Methods This was a retrospective analysis of patient data from a single centre biologic registry, including over 1700 RA patients on at least one biologic drug. We selected 210 patients using consecutive sampling and divided them into two groups: 105 patients enrolled before and 105 enrolled after 2015. Demographic and disease-specific details were extracted. Medians and proportions were used to describe the quantitative and qualitative variables, respectively. Univariate and multivariate analyses were used to identify the factors predicting the diagnosis of D2T RA. A total of 191 patients were used for final analysis after removing entries with missing data. Results Preliminary analysis revealed that 78 patients (40.8%) out of 191 met the criteria for D2T RA among our biologic-experienced cohort. Table 1 depicts the patient characteristics. Our patients were predominantly female (70.7%), with almost two-thirds having multiple comorbidities and 35.6% being smokers. Obesity and osteoarthritis were quite prevalent. Over half the patients were in remission at the last available assessment. Univariate analysis showed that erosive disease, coexistent osteoarthritis, and lack of concurrent csDMARD use were significantly associated with patients meeting the criteria for D2T RA. Multivariate regression revealed only erosive disease as a predictor for RA when corrected for age and gender. Conclusion This audit confirms that D2T RA is a prevalent condition, and its incidence remains significant despite the use of biologic DMARDs. Smoking status, management of comorbidities, and identifying erosive disease early can all lead to better risk-stratification and improved patient outcomes. We aim to validate our findings using a large population sample to identify the gaps in managing RA. Disclosure S. Ghosh: None. R. Yildirim: None. O. Asekhame: None. N. Ravichandran: None.
Ghosh et al. (Wed,) studied this question.