Influence of selected demographic and clinical factors on the treatment of rheumatoid arthritis – a long-term follow-up

Abstract

Robert Kruszewski, Bartłomiej Kisiel, Witold TłustochowiczMethotrexate is recommended as a first-line drug in the treatment of rheumatoid arthritis, however, clinical practice often requires a change in the therapeutic approach. Our objective was to evaluate the influence of several demographic and diseaserelated factors on the treatment of rheumatoid arthritis. A group of 143 rheumatoid arthritis patients, initially treated with methotrexate in monotherapy or in combination with glucocorticoids, was followed for an average of 7.5 years. A search for associations between age, sex, disease onset age, disease duration, body mass index, smoking, rheumatoid factor and anticitrullinated protein antibodies status, initial disease activity, bone erosions and rheumatoid arthritis treatment during the follow-up was performed. Patients receiving biological therapy were younger than those on other types of treatment (50.57 ± 13.39 vs. 58.86 ± 11.67 years; p = 0.0013), had slightly lower disease onset age (41.78±13.03 vs. 47.88 ± 13.74 years; p = 0.035) and more prevalent high levels of anti-citrullinated protein antibodies (91% vs. 66%; p = 0.02). On the other hand, patients on methotrexate monotherapy were older than those receiving other therapies (61.51 ± 10.86 vs. 53.97±12.61 years; p = 0.0002) and had slightly higher disease onset age (52.08 ± 13.20 vs. 42.55 ± 12.82 years; p = 0.000026). Higher initial disease activity (DAS28) was associated with a need for prolonged treatment with biological agents or biological therapy with addition of synthetic disease modifying antirheumatic drugs other than methotrexate. We found no relationships between sex, disease duration, body mass index, smoking or radiological erosions and the type of received disease modifying antirheumatic drug. Patient’s actual age and disease onset age seem to have the most significant impact on rheumatoid arthritis treatment course.