Long-term outcome of a treat-to-target strategy in late-onset rheumatoid arthritis with chronic lung disease: 5-year results of a prospective observational study
Abstract Background Controlling disease activity and improving physical function would be more difficult in patients with late-onset rheumatoid arthritis (LORA) who have chronic lung disease (CLD) at baseline. Our aim was to evaluate 5-year outcomes of following a treat-to-target (T2T) strategy targ...
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BMC
2025-02-01
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| Series: | Arthritis Research & Therapy |
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| Online Access: | https://doi.org/10.1186/s13075-025-03491-1 |
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| author | Manami Nomura Takahiko Sugihara Hiroyuki Baba Tadashi Hosoya Mari Kamiya Tatsuro Ishizaki Takumi Matsumoto Kanae Kubo Fumio Hirano Masayo Kojima Nobuyuki Miyasaka Shinsuke Yasuda Masayoshi Harigai |
| author_facet | Manami Nomura Takahiko Sugihara Hiroyuki Baba Tadashi Hosoya Mari Kamiya Tatsuro Ishizaki Takumi Matsumoto Kanae Kubo Fumio Hirano Masayo Kojima Nobuyuki Miyasaka Shinsuke Yasuda Masayoshi Harigai |
| author_sort | Manami Nomura |
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| description | Abstract Background Controlling disease activity and improving physical function would be more difficult in patients with late-onset rheumatoid arthritis (LORA) who have chronic lung disease (CLD) at baseline. Our aim was to evaluate 5-year outcomes of following a treat-to-target (T2T) strategy targeting low disease activity (LDA) in LORA with CLD. Methods Data from 197 methotrexate (MTX)-naïve LORA patients (mean age 74.4 years) from a prospective, monocentric registry were analyzed. Patients were treated with MTX if they had one or more poor prognostic features. If they had interstitial lung disease (ILD), tacrolimus could be administered instead of MTX at the discretion of the attending physician. If patients exhibited no response according to the European League Against Rheumatism criteria at week 12 or had not achieved LDA by week 24, biological disease-modifying antirheumatic drugs (bDMARDs) were started targeting LDA. The primary outcomes were the 5-year simplified disease activity index (SDAI) remission and Health Assessment Questionnaire Disability Index (HAQ-DI) ≤ 0.5 by non-responder imputation analysis. Secondary outcomes were serious adverse events (SAEs). Results Of the 197 LORA patients, 47 had CLD at baseline. The proportion of patients using MTX at baseline was significantly lower in those with than without CLD. Tacrolimus was initiated in 25.5% of the CLD group. The proportion of patients on bDMARDs was higher in those with CLD at year 5. Achievement of SDAI remission at year 5 was 29.8% in patients with CLD and 44.0% in those without CLD (p = 0.555). Achievement of HAQ-DI ≤ 0.5 at year 5 was 36.2% and 45.3% in patients with and without CLD, respectively (p = 0.939). Non-adherence to T2T due to comorbidities or adverse events was observed in 34.0% and 18.7% of the patients with and without CLD, respectively (p = 0.027). Infections requiring hospitalization, deterioration of extra-articular manifestations and fractures were more frequently reported as SAEs in patients with CLD, and multivariable analysis showed that patients with CLD had a higher risk of developing these SAEs (adjusted hazard ratio:2.53, 95% CI 1.60–4.00, p < 0.001). Conclusion For LORA patients with CLD, the T2T strategy is effective, but comorbidities and SAEs make the implementation of the T2T more difficult. |
| format | Article |
| id | doaj-art-c5dfae612b8e404ca26ae5d8ab09d6e4 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-02-01 |
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| spelling | doaj-art-c5dfae612b8e404ca26ae5d8ab09d6e42025-02-09T12:48:43ZengBMCArthritis Research & Therapy1478-63622025-02-0127111110.1186/s13075-025-03491-1Long-term outcome of a treat-to-target strategy in late-onset rheumatoid arthritis with chronic lung disease: 5-year results of a prospective observational studyManami Nomura0Takahiko Sugihara1Hiroyuki Baba2Tadashi Hosoya3Mari Kamiya4Tatsuro Ishizaki5Takumi Matsumoto6Kanae Kubo7Fumio Hirano8Masayo Kojima9Nobuyuki Miyasaka10Shinsuke Yasuda11Masayoshi Harigai12Department of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science TokyoDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science TokyoDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science TokyoDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science TokyoDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science TokyoHuman Care Research Team, Tokyo Metropolitan Institute for Geriatrics and GerontologyDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science TokyoDepartment of Medicine and Rheumatology, Tokyo Metropolitan Institute for Geriatrics and GerontologyDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science TokyoDepartment of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and GerontologyDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science TokyoDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science TokyoDepartment of Rheumatology, Sanno HospitalAbstract Background Controlling disease activity and improving physical function would be more difficult in patients with late-onset rheumatoid arthritis (LORA) who have chronic lung disease (CLD) at baseline. Our aim was to evaluate 5-year outcomes of following a treat-to-target (T2T) strategy targeting low disease activity (LDA) in LORA with CLD. Methods Data from 197 methotrexate (MTX)-naïve LORA patients (mean age 74.4 years) from a prospective, monocentric registry were analyzed. Patients were treated with MTX if they had one or more poor prognostic features. If they had interstitial lung disease (ILD), tacrolimus could be administered instead of MTX at the discretion of the attending physician. If patients exhibited no response according to the European League Against Rheumatism criteria at week 12 or had not achieved LDA by week 24, biological disease-modifying antirheumatic drugs (bDMARDs) were started targeting LDA. The primary outcomes were the 5-year simplified disease activity index (SDAI) remission and Health Assessment Questionnaire Disability Index (HAQ-DI) ≤ 0.5 by non-responder imputation analysis. Secondary outcomes were serious adverse events (SAEs). Results Of the 197 LORA patients, 47 had CLD at baseline. The proportion of patients using MTX at baseline was significantly lower in those with than without CLD. Tacrolimus was initiated in 25.5% of the CLD group. The proportion of patients on bDMARDs was higher in those with CLD at year 5. Achievement of SDAI remission at year 5 was 29.8% in patients with CLD and 44.0% in those without CLD (p = 0.555). Achievement of HAQ-DI ≤ 0.5 at year 5 was 36.2% and 45.3% in patients with and without CLD, respectively (p = 0.939). Non-adherence to T2T due to comorbidities or adverse events was observed in 34.0% and 18.7% of the patients with and without CLD, respectively (p = 0.027). Infections requiring hospitalization, deterioration of extra-articular manifestations and fractures were more frequently reported as SAEs in patients with CLD, and multivariable analysis showed that patients with CLD had a higher risk of developing these SAEs (adjusted hazard ratio:2.53, 95% CI 1.60–4.00, p < 0.001). Conclusion For LORA patients with CLD, the T2T strategy is effective, but comorbidities and SAEs make the implementation of the T2T more difficult.https://doi.org/10.1186/s13075-025-03491-1Late-onset rheumatoid arthritisTreat-to-targetInterstitial lung diseaseChronic lung diseaseSimplified disease activity index remissionHealth assessment questionnaire disability index |
| spellingShingle | Manami Nomura Takahiko Sugihara Hiroyuki Baba Tadashi Hosoya Mari Kamiya Tatsuro Ishizaki Takumi Matsumoto Kanae Kubo Fumio Hirano Masayo Kojima Nobuyuki Miyasaka Shinsuke Yasuda Masayoshi Harigai Long-term outcome of a treat-to-target strategy in late-onset rheumatoid arthritis with chronic lung disease: 5-year results of a prospective observational study Arthritis Research & Therapy Late-onset rheumatoid arthritis Treat-to-target Interstitial lung disease Chronic lung disease Simplified disease activity index remission Health assessment questionnaire disability index |
| title | Long-term outcome of a treat-to-target strategy in late-onset rheumatoid arthritis with chronic lung disease: 5-year results of a prospective observational study |
| title_full | Long-term outcome of a treat-to-target strategy in late-onset rheumatoid arthritis with chronic lung disease: 5-year results of a prospective observational study |
| title_fullStr | Long-term outcome of a treat-to-target strategy in late-onset rheumatoid arthritis with chronic lung disease: 5-year results of a prospective observational study |
| title_full_unstemmed | Long-term outcome of a treat-to-target strategy in late-onset rheumatoid arthritis with chronic lung disease: 5-year results of a prospective observational study |
| title_short | Long-term outcome of a treat-to-target strategy in late-onset rheumatoid arthritis with chronic lung disease: 5-year results of a prospective observational study |
| title_sort | long term outcome of a treat to target strategy in late onset rheumatoid arthritis with chronic lung disease 5 year results of a prospective observational study |
| topic | Late-onset rheumatoid arthritis Treat-to-target Interstitial lung disease Chronic lung disease Simplified disease activity index remission Health assessment questionnaire disability index |
| url | https://doi.org/10.1186/s13075-025-03491-1 |
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