Targeting mental health, pain-related conditions may improve treatment outcomes for refractory rheumatoid arthritis

Targeting mental health, pain-related conditions may improve treatment outcomes for refractory rheumatoid arthritis

Image source: Adobe Stock/Satjawat

Targeting mental health, pain-related conditions may improve treatment outcomes for refractory rheumatoid arthritis

In patients with treatment-resistant (D2T) rheumatoid arthritis (RA), mental health, pain-related conditions, and metabolic diseases may lead to long-term adverse outcomes. Therefore, health care teams should target these to optimize the long-term course of this heterogeneous patient population, according to a study published in the Journal of Medicine. Rheumatic and musculoskeletal diseases.1

Although new targeted therapies have greatly improved the prognosis of patients with RA, there are still a subset of patients for whom targeted therapies fail to adequately control disease activity. These patients are classified as “difficult to treat.”2

“D2T RA represents a group of patients with unmet needs that have been at the center of RA clinical research over the past few years,” wrote George Bertsias, PhD, a researcher in the Department of Clinical Immunology and Allergy at the University School of Medicine in Crete, Greece, and colleagues them.

To better understand heterogeneity and factors associated with long-term outcomes, we recruited adult patients from the University of Crete Rheumatology Clinical Registry (UCRCR) prospective single-center cohort. D2T was defined using European League of Rheumatology Societies (EULAR) criteria, which includes patients who have failed ≥2 biological or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) categories or are currently receiving a second b/tsDMARD. Patients treated with tsDMARDs had disease activity score 28 erythrocyte sedimentation rate (DAS28-ESR) scores ≥3.2 in all measurements.

The cohort collected data on demographics, comorbidities, disease activity and characteristics, functioning, and quality of life after initial b/tsDMARD initiation, then 3–6 months during the first 2 years, and annually thereafter.

Latent class trajectory analysis used longitudinal clustering of functional status (determined by the modified health assessment questionnaire (mHAQ)) and disease activity (assessed using DAS28). Multiple linear mixed models were used to evaluate the impact of comorbidities and their clusters on long-term outcomes in D2T RA.

Of the 1264 RA patients included (81.2% female), 251 (19.9%) were classified as D2T. Significant predictors of becoming D2T included younger age, diagnosis of osteoarthritis or fibromyalgia, failure to reduce DAS28-ESR within the first 6 months of treatment with ab/tsDMARD, and DAS28-ESR when first starting b/tsDMARD.

Long-term follow-up (5872 person-years total) revealed four groups of functional status: stable, mildly impaired mHAQ (18.2%, mean 0.41); progressive improvement (39.9%, 1.21-.87); and two groups with slowly worsening or stable significant functional impairment (HAQ>1).

In addition, 4 groups of disease activity evolution were identified: stable moderate disease activity (8.3%); gradual improvement from high to moderate disease activity (38%), and 2 groups with significant disease activity throughout the follow-up period but higher (total 53.6%).

The presence of “mental health and pain-related disorders” and “metabolic disorders” were significantly associated with worsening of mHAQ (phosphorus <.0001 for both) and DAS28 Evolution (phosphorus <.0001 and phosphorus = .018, respectively).

This finding was confirmed by prospective monitoring of a large cohort of patients in a real-life clinical setting by experienced rheumatologists using the same protocol. However, the researchers noted that the observational nature of the study design, including incomplete follow-up records, patients lost to follow-up, and missing covariates, limited the results. To address this issue, the researchers decided to exclude patients whose data could not be classified as D2T due to missing data.

“A group of patients with a lower burden of ‘mental health and pain-related conditions’ and ‘metabolic disease’ showed the most favorable outcomes, highlighting the importance of targeting these common comorbidities, as well as the inflammatory burden of RA, to improve outcomes for these patients,” ” the researchers concluded. “Our results indicate that disease clusters identified as significantly different between trajectory groups are also significant predictors of DAS28 or HAQ scores.”

refer to

  1. Bertsias A, Flouri ID, Repa A, et al. Patterns of comorbidities have differential effects on long-term functional evolution and disease activity in patients with “difficult-to-treat” rheumatoid arthritis. RMD Open. 2024;10(1):e003808. Published on January 19, 2024. doi:10.1136/rmdopen-2023-003808
  2. Tan Y, Buch MH. Difficult-to-treat rheumatoid arthritis: Current status and next steps considerations. RMD Open 2022;8:e002387. doi:10.1136/rmdopen-2022-002387

Leave a Comment

Your email address will not be published. Required fields are marked *