Publisher

UNIVMEDUNIVMED

Journal Universa MedicinaUniversa Medicina Abstract

BACKGROUND. Methotrexate (MTX) is the firstline therapy for rheumatoid arthritis (RA). However, 30–40% of RA patients exhibit poor response. Identifying early factors associated with persistent disease activity is critical to guide treatment. This study aimed to identify predictors of persistent high disease activity (DAS28-ESR >3.2) after six months of MTX therapy in RA patients.. . METHODS. A retrospective cohort study was conducted involving 204 RA patients who had completed six months of MTX therapy. The primary outcome was DAS28-ESR score at six months. Independent variables included baseline erythrocyte sedimentation rate (ESR), cumulative doses of MTX and low-dose methylprednisolone (LDM), and rheumatoid factor (RF) status. Simple and multiple logistic regression was used to analyze the data.. . RESULTS. Significant differences in ESR and cumulative MTX dose were observed between low and high disease activity groups. Multivariate analysis identified four independent predictors of persistent high disease activity (DAS28-ESR >3.2) after six months of MTX therapy: disease duration >11 months (AOR =0.45; 95% CI 0.23–0.89; p=0.025); age at onset >50 years (AOR 0.48; 95% CI 0.24–0.94; p=0.038); cumulative MTX dose >85 mg (AOR 4.75; 95% CI 1.55–14.64; p=0.006); ESR >66 mm/hr (AOR 2.32; 95% CI 1.11–4.89; p=0.026).. . CONCLUSION. Greater cumulative methotrexate dose (>85 mg) was the most influential predictor of persistent high disease activity (DAS28-ESR >3.2) after six months of MTX therapy in RA patients. These findings may assist clinicians in identifying patients at risk for poor MTX response and support timely therapeutic adjustments.

Conclusion

Greater cumulative methotrexate dose (>85 mg) was the most influential predictor of persistent high disease activity after six months of MTX therapy in RA patients.This finding can help clinicians identify patients at risk for poor MTX response.Timely therapeutic adjustments are supported by these results.The study identified disease duration, age at onset, and ESR as additional independent predictors of persistent high disease activity.

Future Research

Penelitian lebih lanjut perlu dilakukan untuk mengidentifikasi biomarker genetik dan epigenetik yang dapat memprediksi respons terhadap metotreksat pada pasien rheumatoid arthritis. Studi prospektif dengan kohort yang lebih besar dan beragam diperlukan untuk memvalidasi temuan ini dan mengembangkan model prediksi yang lebih akurat. Selain itu, penelitian harus mengeksplorasi peran faktor psikososial, seperti tingkat stres dan dukungan sosial, dalam memengaruhi respons terhadap pengobatan dan hasil klinis pada pasien rheumatoid arthritis. Investigasi lebih lanjut mengenai interaksi antara dosis metotreksat, biomarker inflamasi, dan faktor-faktor klinis lainnya dapat membantu mengoptimalkan strategi pengobatan individual dan meningkatkan hasil jangka panjang bagi pasien rheumatoid arthritis.

References

1. Impact of obesity on clinical outcomes and treatment continuation in rheumatoid arthritis patients receiving... journals.sagepub.com/doi/10.1177/1759720X241308027Impact of obesity on clinical outcomes and treatment continuation in rheumatoid arthritis patients receiving journals sagepub doi 10 1177 1759720X241308027
2. Universa Medicina. predictors persistent high disease activity methotrexate treatment rheumatoid arthritis... doi.org/10.18051/UnivMed.2025.v44.141-151Universa Medicina predictors persistent high disease activity methotrexate treatment rheumatoid arthritis doi 10 18051 UnivMed 2025 v44 141 151

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