Obesity and fibromyalgia are associated with Difficult-to-Treat Rheumatoid Arthritis (D2T-RA) independent of age and gender
Abstract Background There is still a significant proportion of patients with rheumatoid arthritis (RA) in whom multiple therapeutic lines are ineffective. These cases are defined by the EULAR criteria as Difficult-to-Treat RA (D2T-RA) for which there is limited knowledge of predisposing factors. Obj...
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BMC
2025-01-01
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| Series: | Arthritis Research & Therapy |
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| Online Access: | https://doi.org/10.1186/s13075-024-03432-4 |
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| author | Nicoletta Luciano Elisa Barone Enrico Brunetta Alessio D’Isanto Maria De Santis Angela Ceribelli Marta Caprioli Giacomo M. Guidelli Daniela Renna Carlo Selmi |
| author_facet | Nicoletta Luciano Elisa Barone Enrico Brunetta Alessio D’Isanto Maria De Santis Angela Ceribelli Marta Caprioli Giacomo M. Guidelli Daniela Renna Carlo Selmi |
| author_sort | Nicoletta Luciano |
| collection | DOAJ |
| description | Abstract Background There is still a significant proportion of patients with rheumatoid arthritis (RA) in whom multiple therapeutic lines are ineffective. These cases are defined by the EULAR criteria as Difficult-to-Treat RA (D2T-RA) for which there is limited knowledge of predisposing factors. Objective To identify the clinical features associated with D2T-RA in real-life practice. Methods We retrospectively collected demographic, clinical, and serological data on 458 patients consecutively seen for RA between January 2019 and January 2023. We compared patients fulfilling the D2T-RA criteria with the remaining RA cohort using univariate comparisons and logistic regression to determine the impact of clinical features, comorbidities on outcome variable, adjusted for confounders. Results Seventy-one/458 (16%) patients fulfilled the 2021 EULAR criteria for D2T-RA with no significant differences for age (median 62 years interquartile range -IQR- 58- 65 vs. 62 IQR 60 – 63 in non-D2T), gender prevalence (23% in both groups) and positivity rates for rheumatoid factors (62% vs. 62% in non-D2T) and Anti-Citrullinated Protein Antibodies (ACPA) (69% vs. 61% in non-D2T). Conversely, D2T-RA cases had significant longer disease duration (median 15 years IQR 13–17 vs. 10 years IQR 9–11 in non-D2T; p < 0.0001). D2T-RA also had more erosions at baseline (24% vs. 11% in non-D2T; p < 0.0001) and higher disease activity index (CDAI) at the last follow up visit (15.7 ± 10.5 vs. 7.5 ± 8.8 in non-D2T; p < 0.0001). D2T-RA cases suffered with higher frequency of obesity (33% vs. 19% in non-D2T, p = 0.021) and fibromyalgia (25% vs. 10% in non-D2T, p < 0.0001). The multivariate analysis confirmed the correlations of D2T-RA with disease duration (Odds ratio -OR- 1.06, 95% confidence interval -CI—1.03–1.09; p < 0.0001), baseline erosions (OR 2.73, 95% CI 1.28–5.82; p = 0.009), obesity (OR 2.22, 95% CI 1.10–4.50; p = 0.026) and fibromyalgia (OR 3.91, 95% CI 1.76–8.70; p = 0.001), independent of age and gender. Conclusions High disease activity, baseline erosions and disease duration are significantly associated with the D2T phenotype of RA while we confirm the importance of obesity and fibromyalgia. |
| format | Article |
| id | doaj-art-4b6bdc96f19f45999a25715f2c6aa996 |
| institution | Kabale University |
| issn | 1478-6362 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Arthritis Research & Therapy |
| spelling | doaj-art-4b6bdc96f19f45999a25715f2c6aa9962025-01-05T12:42:20ZengBMCArthritis Research & Therapy1478-63622025-01-012711910.1186/s13075-024-03432-4Obesity and fibromyalgia are associated with Difficult-to-Treat Rheumatoid Arthritis (D2T-RA) independent of age and genderNicoletta Luciano0Elisa Barone1Enrico Brunetta2Alessio D’Isanto3Maria De Santis4Angela Ceribelli5Marta Caprioli6Giacomo M. Guidelli7Daniela Renna8Carlo Selmi9Department of Biomedical Sciences, Humanitas UniversityDepartment of Biomedical Sciences, Humanitas UniversityDepartment of Biomedical Sciences, Humanitas UniversityDepartment of Biomedical Sciences, Humanitas UniversityDepartment of Biomedical Sciences, Humanitas UniversityDepartment of Biomedical Sciences, Humanitas UniversityRheumatology and Clinical Immunology, IRCCS Humanitas Research HospitalRheumatology and Clinical Immunology, IRCCS Humanitas Research HospitalRheumatology and Clinical Immunology, IRCCS Humanitas Research HospitalDepartment of Biomedical Sciences, Humanitas UniversityAbstract Background There is still a significant proportion of patients with rheumatoid arthritis (RA) in whom multiple therapeutic lines are ineffective. These cases are defined by the EULAR criteria as Difficult-to-Treat RA (D2T-RA) for which there is limited knowledge of predisposing factors. Objective To identify the clinical features associated with D2T-RA in real-life practice. Methods We retrospectively collected demographic, clinical, and serological data on 458 patients consecutively seen for RA between January 2019 and January 2023. We compared patients fulfilling the D2T-RA criteria with the remaining RA cohort using univariate comparisons and logistic regression to determine the impact of clinical features, comorbidities on outcome variable, adjusted for confounders. Results Seventy-one/458 (16%) patients fulfilled the 2021 EULAR criteria for D2T-RA with no significant differences for age (median 62 years interquartile range -IQR- 58- 65 vs. 62 IQR 60 – 63 in non-D2T), gender prevalence (23% in both groups) and positivity rates for rheumatoid factors (62% vs. 62% in non-D2T) and Anti-Citrullinated Protein Antibodies (ACPA) (69% vs. 61% in non-D2T). Conversely, D2T-RA cases had significant longer disease duration (median 15 years IQR 13–17 vs. 10 years IQR 9–11 in non-D2T; p < 0.0001). D2T-RA also had more erosions at baseline (24% vs. 11% in non-D2T; p < 0.0001) and higher disease activity index (CDAI) at the last follow up visit (15.7 ± 10.5 vs. 7.5 ± 8.8 in non-D2T; p < 0.0001). D2T-RA cases suffered with higher frequency of obesity (33% vs. 19% in non-D2T, p = 0.021) and fibromyalgia (25% vs. 10% in non-D2T, p < 0.0001). The multivariate analysis confirmed the correlations of D2T-RA with disease duration (Odds ratio -OR- 1.06, 95% confidence interval -CI—1.03–1.09; p < 0.0001), baseline erosions (OR 2.73, 95% CI 1.28–5.82; p = 0.009), obesity (OR 2.22, 95% CI 1.10–4.50; p = 0.026) and fibromyalgia (OR 3.91, 95% CI 1.76–8.70; p = 0.001), independent of age and gender. Conclusions High disease activity, baseline erosions and disease duration are significantly associated with the D2T phenotype of RA while we confirm the importance of obesity and fibromyalgia.https://doi.org/10.1186/s13075-024-03432-4Rheumatoid arthritisBiologicsTreat-to-target |
| spellingShingle | Nicoletta Luciano Elisa Barone Enrico Brunetta Alessio D’Isanto Maria De Santis Angela Ceribelli Marta Caprioli Giacomo M. Guidelli Daniela Renna Carlo Selmi Obesity and fibromyalgia are associated with Difficult-to-Treat Rheumatoid Arthritis (D2T-RA) independent of age and gender Arthritis Research & Therapy Rheumatoid arthritis Biologics Treat-to-target |
| title | Obesity and fibromyalgia are associated with Difficult-to-Treat Rheumatoid Arthritis (D2T-RA) independent of age and gender |
| title_full | Obesity and fibromyalgia are associated with Difficult-to-Treat Rheumatoid Arthritis (D2T-RA) independent of age and gender |
| title_fullStr | Obesity and fibromyalgia are associated with Difficult-to-Treat Rheumatoid Arthritis (D2T-RA) independent of age and gender |
| title_full_unstemmed | Obesity and fibromyalgia are associated with Difficult-to-Treat Rheumatoid Arthritis (D2T-RA) independent of age and gender |
| title_short | Obesity and fibromyalgia are associated with Difficult-to-Treat Rheumatoid Arthritis (D2T-RA) independent of age and gender |
| title_sort | obesity and fibromyalgia are associated with difficult to treat rheumatoid arthritis d2t ra independent of age and gender |
| topic | Rheumatoid arthritis Biologics Treat-to-target |
| url | https://doi.org/10.1186/s13075-024-03432-4 |
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