Pos0675 Differences in the Characteristics of D2t/Nond2t-Ra Patients and Factors Associated With D2t-Ra at B/Tsdmard Start

Background: Rheumatoid arthritis (RA) is a common rheumatic disease characterised by joint damage and reduced quality of life. Despite numerous treatment options, some patients do not achieve remission or low disease activity. These patients have been defined as having difficult-to-treat RA (D2T-RA) by the European Alliance of Associations for Rheumatology (EULAR) 20211. Objectives: This study was conducted to determine the prevalence of 'difficult-to-treat' RA in our centre and the factors associated with D2T at biologic/targeted synthetic disease modifying anti-rheumatic drug (b/tsDMARD) initiation. Methods: Patients who applied to the outpatient clinic of Hacettepe University Department of Internal Medicine, Division of Rheumatology between 1 April-30 November 2023 with a diagnosis of RA and using b/tsDMARD were included in this study. Patients fulfilling all three EULAR D2T RA criteria were accepted as D2T RA 1. Patients were cross-sectionally divided into D2T and non-D2T based on their visit dates between the study periods. Patients were defined as D2T-RA when they met; A: Failure of ≥2 bDMARDs/tsDMARDs (with different mechanisms of action) after treatment according to EULAR recommendations and failure of conventional synthetic DMARDs (unless contraindicated); AND B: Presence of at least one of the following: moderate or more severe disease activity (DAS28 ≥3. 2), signs and/or symptoms consistent with active disease (elevated erythrocyte sedimentation rate (ESR) for age, C-reactive protein ≥0.5), inability to reduce steroid therapy below prednisolone 7.5 mg or equivalent, and RA symptoms affecting quality of life (Health Assessment Questionnaire, HAQ ≥1.2). AND C: Management of signs and/or symptoms perceived as problematic by the rheumatologist and/or the patient (Physician Global Assessment or Patient Global Assessment VAS ≥50 or Patient Acceptable Symptom State (PASS) negative). Radiographic progression was not included in this assessment as it was not available. Demographic, clinical and treatment data were assessed at the time of b/tsDMARD initiation according to D2T status. And comorbidities were assessed for any diagnosis ever made. To understand the factors that are associated with D2T-RA at b/tsDMARD initiation, a 1:1 matched cohort for b/tsDMARD duration were created. The factors associated with D2T status on univariate analysis with significance at the 0.20 level were entered into a multivariable model. Backward elimination method was used at a significance of 0.05 level. Results: A total of 502 patients were evaluated. Of these, 38.4% had D2T RA with a mean (SD) age of 56.7 (12.1) years and 85.6% were female. Compared to the non-D2T patients, the D2T patients had a significantly higher body mass index and tender joint counts, but no difference was observed in the treatment strategies used before thE b/ts DMARD start (Table 1). Regarding comorbidities, D2T patients had higher rates of ever made diagnosis of hypertension (90 (46.4%) vs 96 (31.1%), p=0.001) and coronary artery disease (20 (24.4%) vs 12 (11.3%), p=0.018), with no significant difference in diabetes mellitus, osteoporosis and malignancy (p >0.1 for all). When D2T patients were matched to non-D2T patients according to the b/tsdmard duration, there were 173 patients from 2 groups with a mean (SD) b/tsDMARD duration of 6.3 (7.2) years. Final model revealed, HAQ score ≥ 1 at b/tsDMARD start as a factor for D2T-RA (OR 2.08 (1.17-3.69), p= 0.01) (Table 2). Conclusion: There are nearly 40% of patients determined as D2T in our cohort. The high rates can be attributed to the cohort characteristics as this is a b/tsDMARD cohort which required advanced treatment from the start and patients were under follow-up. HAQ score ≥ 1 at the time of b/tsDMARD start, is an independent factor associated with D2T-RA in the future. REFERENCES: 1 Nagy G, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2021;80(1):31-5. Table 1. Demographic, clinical and therapeutic characteristics of D2T patients at b/tsDMARD initiation Table 2. Factors that are associated with being DT2 in the future when starting a b/tsDMARD (D2T RA patients, n=173, non-D2T-RA patients, n=173) Acknowledgements: NIL. Disclosure of Interests: None declared.