Poor prognostic factors independently impact remission and treatment escalation in rheumatoid arthritis regardless of disease activity: A nationwide prospective cohort study

Abstract

Objective: To elucidate the impact of poor prognostic factors (PPFs) in daily practice on achieving remission and the requirement for biologic or targeted synthetic DMARDs (b/tsDMARDs) in a large Korean cohort of patients with rheumatoid arthritis (RA).Methods: Using the KORean Observational study Network for Arthritis (KORONA) database, patients with RA were categorized into three groups based on the number of PPFs (0–1, 2, or ≥3): the presence of functional limitation, extra-articular disease, seropositivity, and bone erosions. Factors related to achieving remission and to initiating b/tsDMARDs were evaluated using Cox proportional hazard regression analyses after adjusting confounders.Results: Among 5,076 patients with RA, Group L (PPF ≤1), Group M (PPFs 2), and Group H (PPFs ≥3) were 1,788 (35.2%), 2,027 (39.9%), and 1,261 (24.9%), respectively. Group H had higher disease activity and worse patient-reported outcomes than Groups L and M. Among moderately-to-highly active patients at baseline, Group H was significantly less likely to attain point (hazard ratio [HR]=0.55, 95% confidence interval [CI] 0.38–0.79) and sustained (HR=0.45, 95% CI 0.21-0.99) Boolean-based remission in 5-year. Groups M (HR=1.47, 95% CI 1.10–1.96) and H (HR=1.69, 95% CI 1.22–2.32) had an increased risk of escalation to b/tsDMARDs, compared to Group L among b/tsDMARDs-naïve patients at baseline.Conclusion: Achieving remission was particularly challenging for Group H, and more patients in Groups M and H initiated b/tsDMARDS during the 5-year observation period. Therefore, the presence of PPFs ≥3 significantly influences both patients' outcomes and clinician's treatment decisions regardless of disease activity.