Obesity and Fibromyalgia Linked to Difficult-to-Treat RA

TOPLINE:

The presence of erosions at diagnosis, longer disease duration, and comorbidities such as fibromyalgia and obesity are associated with the development of difficult-to-treat rheumatoid arthritis (RA).

METHODOLOGY:

• Researchers conducted a retrospective cross-sectional study to assess the impact of clinical features and comorbidities on the subsequent development of difficult-to-treat RA.
• They included 458 patients with RA (median age, 62 years; 77% women) observed at the Humanitas Research Hospital in Milan, Italy, between January 2019 and January 2023. 
• Patients were classified as having difficult-to-treat RA on the basis of the 2021 EULAR criteria. 
• Data on comorbidities such as obesity and fibromyalgia were collected. The presence of erosions and disease activity, assessed using the Clinical Disease Activity Index (CDAI), were recorded at baseline and the last follow-up visit.

TAKEAWAY:

• Across the entire cohort, 22% of patients fulfilled the criteria for difficult-to-treat RA.
• Compared with patients without difficult-to-treat RA, those with difficult-to-treat RA had a longer disease duration (median, 10 vs 15 years; P P  .0001), and more frequent use of Janus kinase inhibitors (29% vs 56%; P
• A longer disease duration (adjusted odds ratio [aOR], 1.06 for every additional year; P P = .009) were associated with the development of difficult-to-treat RA, independent of age and sex.
• Obesity and fibromyalgia were also associated with the development of difficult-to-treat RA (aOR, 2.22; P = .026 and 3.91; P = .001, respectively).

IN PRACTICE:

“The implementation of biopsy- and biomarker-driven trials will allow to better elucidate such important issues and, hopefully, to progressively abandon the ‘trial and error’ approach in favour of a precision medicine model aimed at controlling the disease earlier, thus possibly reducing the risk of developing D2T-RA [difficult-to-treat RA],” the authors wrote.

SOURCE:

The study was led by Nicoletta Luciano, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy. It was published online on January 3, 2025, in Arthritis Research & Therapy.

LIMITATIONS:

The study’s retrospective nature and the absence of variables such as socioeconomic status limited its findings. The lack of disease activity measures at baseline for a significant proportion of patients could have affected the analysis. The patients’ perspective on disease management could not be assessed precisely.

DISCLOSURES:

The study reported no specific funding. Some authors disclosed receiving consulting or speaker fees from various pharmaceutical companies. One author reported receiving research support.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.