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Madrid-Garcia, AAuthor

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May 29, 2024
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Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease

Publicated to:Rmd Open. 9 (1): e002842- - 2023-03-01 9(1), DOI: 10.1136/rmdopen-2022-002842

Authors: Leon, L; Madrid-Garcia, A; Lopez-Viejo, P; González-Alvaro, I; Novella-Navarro, M; Nuñez, DF; Rosales, Z; Fernandez-Gutierrez, B; Abasolo, L

Affiliations

CENTRO DE TECNOLOGIA BIOMEDICA (CTB). Universidad Politécnica de Madrid - Author
Hosp Clin Univ San Carlos, IdISSC & Rheumatol - Author
Hosp Clin Univ San Carlos, Rheumatol - Author
Hosp Univ La Paz, Rheumatol - Author
Hosp Univ Princesa, Rheumatol - Author
Univ Camilo Jose Cela, Hlth Sci - Author
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Abstract

ObjectivesMost studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyse whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analysed.MethodsA longitudinal multicentre study of patients with RA was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease and management being perceived as problematic by the rheumatologist and/or patient). The main variable was disease activity in the early stages. The covariates were sociodemographic, clinical and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA.ResultsThe study population comprised 631 patients and 35 (5.87%) developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, 28-joint Disease Activity Score (DAS28) score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.89; p=0.01).ConclusionsIn this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that younger patients and those with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.

Keywords

ArthritisBiological therapyHealth careMethotrexateOpportunityOutcome assessmentPersistenceRecommendationsRheumatoidWindow

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Rmd Open due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position 8/57, thus managing to position itself as a Q1 (Primer Cuartil), in the category Rheumatology.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 15.04, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Oct 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-10-24, the following number of citations:

  • WoS: 4
  • Google Scholar: 5

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-10-24:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 33.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 33 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 1.
  • The number of mentions on the social network X (formerly Twitter): 1 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.