Five-year follow-up of patients with difficult-to-treat rheumatoid arthritis

Objectives To elucidate the long-term outcomes of patients with difficult-to-treat rheumatoid arthritis (D2T RA).Methods We collected data on the clinical course of patients who had been identified as D2T RA in 2018 until 2023. We stratified the patients according to outcomes at the last visit: resolved D2T RA, persistent D2T RA and mortality. We compared their clinical characteristics and investigated the predictive factors for the resolution of D2T RA or mortality. Furthermore, we investigated the impact of the causes of D2T RA identified in 2018, multidrug resistance, comorbidities and socioeconomic factors on outcomes in 2023.Results Of 173 patients identified as D2T RA in 2018, 150 were included in the analysis. Among them, D2T RA was resolved in 67 (45%), 75 (50%) remained as D2T RA, and 8 (5%) died. Patients with resolved D2T RA were significantly younger at the latest visit (P = 0.02), had a higher proportion of treatment changes during five years (P = 0.002), and had a higher proportion of interleukin-6 receptor inhibitors use in 2023 (P = 0.04) than those in patients with persistent D2T RA or those who died. D2T RA resolved in 38% of patients with multidrug resistance, mainly with treatment changes. Rheumatic disease comorbidity index and glucocorticoid dose escalation were independent risk factors for mortality [odds ratio (OR), 3.50; P = 0.02 and OR, 31.9; P = 0.002, respectively].Conclusion Further modifications in RA treatment are useful for resolving D2T RA. Multiple comorbidities and glucocorticoid use are associated with mortality.