Rheumatoid arthritis (RA) patients sometimes exhibit different levels of improvement in health assessment questionnaire-disability index (HAQ-DI) and subjective pain visual analogue score (VAS) even after achieving low disease activities (LDA). This study aimed to identify factors associated with improvement in HAQ-DI and pain VAS among those who achieved LDA. Data of the FIRST registry, a multi-institutional cohort of RA patients treated with biological and targeted-synthetic DMARDs (b/tsDMARDs) were analyzed. Patients who were enrolled from August 2013 to February 2023 and who achieved clinical LDA [clinical disease activity index (CDAI) ≤ 10.0] at 6 months after starting treatment were included. Multiple logistic regression analyses were conducted to identify the factors that associated with achieving HAQ-DI normalization (< 0.5), HAQ-DI improvement (by > 0.22), or pain VAS reduction (≤ 40 mm). Among 1424 patients who achieved LDA at 6 months, 732 patients achieved HAQ-DI normalization and 454 achieved pain VAS reduction. The seropositivity and the use of JAK inhibitor compared with TNF inhibitor were associated with both HAQ-DI < 0.5 and pain VAS reduction at 6 months. On the other hand, older age, past failure in ≥ 2 classes of b/tsDMARDs, higher HAQ-DI at baseline, and use of glucocorticoid were associated with the lower likelihood of HAQ-DI normalization and pain VAS reduction. Longer disease duration, being female, and higher disease activity at baseline was negatively associated HAQ-DI normalization alone. Comorbidities were not associated with the outcomes. These results suggest some preferable treatment may exist for improvement of HAQ-DI and pain VAS reduction in the early stage of the treatment, which is a clue to prevention of a criteria of difficult-to-treat RA.

中文翻译：

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使用缓解疾病抗风湿药物实现低疾病活动度的类风湿关节炎患者功能改善和疼痛减轻的预测因素：FIRST 登记处的回顾性研究


类风湿性关节炎（RA）患者有时即使在达到低疾病活动度（LDA）后，健康评估问卷-残疾指数（HAQ-DI）和主观疼痛视觉模拟评分（VAS）也表现出不同程度的改善。本研究旨在确定与获得 LDA 的患者 HAQ-DI 和疼痛 VAS 改善相关的因素。对 FIRST 登记处的数据进行了分析，该登记处是一组接受生物和靶向合成 DMARD (b/tsDMARD) 治疗的 RA 患者的多机构队列。纳入2013年8月至2023年2月期间入组且在开始治疗后6个月时达到临床LDA[临床疾病活动指数（CDAI）≤10.0]的患者。进行多重逻辑回归分析以确定与实现 HAQ-DI 正常化 (< 0.5)、HAQ-DI 改善 (> 0.22) 或疼痛 VAS 减少 (≤ 40 mm) 相关的因素。在 6 个月时达到 LDA 的 1424 名患者中，732 名患者实现 HAQ-DI 正常化，454 名患者实现疼痛 VAS 减轻。与 TNF 抑制剂相比，血清阳性和 JAK 抑制剂的使用与 HAQ-DI < 0.5 和 6 个月时疼痛 VAS 降低相关。另一方面，年龄较大、既往 ≥ 2 类 b/tsDMARD 失败、基线时较高的 HAQ-DI 以及糖皮质激素的使用与 HAQ-DI 正常化和疼痛 VAS 降低的可能性较低相关。较长的病程、女性以及基线时较高的疾病活动度仅与 HAQ-DI 正常化呈负相关。合并症与结果无关。 这些结果表明，可能存在一些更好的治疗方法，可以在治疗的早期阶段改善 HAQ-DI 和减少疼痛 VAS，这是预防难治性 RA 标准的线索。