Poor Prognostic Factors Associated With Disease Progression in Patients With RA

The rate of disease progression in patients with rheumatoid arthritis (RA) can be associated with a poor prognosis in patients. A study recently investigated patients with RA through the number of poor prognostic factors (PPF), finding that the number of PPFs did not significantly predict biologic or biologic/targeted synthetic disease-modifying antirheumatic drug (tsDMARD).

The researchers used the Corrona Rheumatoid Arthritis Registry to identify biologic-naïve patients who have been diagnosed with RA and had a 12-month follow-up, from January 2005 to December 2015. The registry was also used to categorize patients by PPF, while changes in medication, Clinical Disease Activity Index (CDAI), and work status were assessed with linear and logistic regression models.

“The presence of many [PPFs] in patients with recent-onset RA has been associated with increased risk of disease progression in both clinical trials and observational studies,” the authors stated. “However, a single, universal list of PPF does not exist in RA, and there are important distinctions between how these factors are described by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR).”

PPFs that were considered in the analysis included functional limitation, extraarticular disease, seropositivity, and erosions, which were used to evaluate treatment acceleration, clinical outcomes, and work status over the course of 12-months.

Of the 3458 patients who were included in the study, 43.1% had 0-1 PPF, 35.1% had 2 PPFs, and 21.8% had ≥3 PPF. The patients with ≥3 PPF at baseline were older, had longer RA duration, and had higher CDAI than the patients with 0-1 PPF. Additionally, in the 0-1 group, 20.9% of patients received ≥1 biologic, in the 2 PPF group 23.2% received ≥1 biologic, and 26.5% of patients received ≥1 biologic in the ≥3 PPF group.

The researchers found that tsDMARD use was similar in patients with and without PPF. Also, after adjusting for baseline CDAI, the mean change in CDAI was —4.95 for 0-1 PPF group, –4.53 for 2 PPF group, and –2.52 for the ≥3 PPF group. As for working status, there were more patients at baseline but not at the 12-month follow-up in the 2 (13.9%) and ≥3 (12.5%) PPF groups compared with the 0-1 (7.3%) PPF group.

“These findings suggest that the presence of PPF does not notably influence clinicians’ treatment decisions. This strategy warrants reconsideration because patients with a greater number of PPF had worse outcomes (including reduction in CDAI and achievement of LDA/remission) and were less likely to be in full-time or part-time work compared with those with fewer PPF in adjusted analyses,” concluded the authors. “As the definition of a treat-to-target approach in RA evolves, providers may wish to consider incorporating the number of PPF into their conversations with patients regarding their treatment plan.”

Reference

Alemao E, Litman HJ, Connolly SE, et al. Do poor prognostic factors in rheumatoid arthritis affect treatment choices and outcomes? analysis of a US rheumatoid arthritis registry. [published online July 1, 2018]. J Rheumatol. doi: 10.3899/jrheum.171050.