POS0675 DIFFERENCES IN THE CHARACTERISTICS OF D2T/NOND2T-RA PATIENTS AND FACTORS ASSOCIATED WITH D2T-RA AT B/TSDMARD START (2024)

Methods: Patients who applied to the outpatient clinic of Hacettepe University Department of Internal Medicine, Division of Rheumatology between 1 April-30 November 2023 with a diagnosis of RA and using b/tsDMARD were included in this study. Patients fulfilling all three EULAR D2T RA criteria were accepted as D2T RA [1]. Patients were cross-sectionally divided into D2T and non-D2T based on their visit dates between the study periods.

Patients were defined as D2T-RA when they met; A: Failure of ≥2 bDMARDs/tsDMARDs (with different mechanisms of action) after treatment according to EULAR recommendations and failure of conventional synthetic DMARDs (unless contraindicated); AND B: Presence of at least one of the following: moderate or more severe disease activity (DAS28 ≥3. 2), signs and/or symptoms consistent with active disease (elevated erythrocyte sedimentation rate (ESR) for age, C-reactive protein ≥0.5), inability to reduce steroid therapy below prednisolone 7.5 mg or equivalent, and RA symptoms affecting quality of life (Health Assessment Questionnaire, HAQ ≥1.2). AND C: Management of signs and/or symptoms perceived as problematic by the rheumatologist and/or the patient (Physician Global Assessment or Patient Global Assessment VAS ≥50 or Patient Acceptable Symptom State (PASS) negative). Radiographic progression was not included in this assessment as it was not available. Demographic, clinical and treatment data were assessed at the time of b/tsDMARD initiation according to D2T status. And comorbidities were assessed for any diagnosis ever made. To understand the factors that are associated with D2T-RA at b/tsDMARD initiation, a 1:1 matched cohort for b/tsDMARD duration were created. The factors associated with D2T status on univariate analysis with significance at the 0.20 level were entered into a multivariable model. Backward elimination method was used at a significance of 0.05 level.

REFERENCES: [1] Nagy G, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2021;80(1):31-5.

Table 1. Demographic, clinical and therapeutic characteristics of D2T patients at b/tsDMARD initiation

Table 2. Factors that are associated with being DT2 in the future when starting a b/tsDMARD (D2T RA patients, n=173, non-D2T-RA patients, n=173)