Evidence map›Paper›PMID 40684221›Full record

Observational studyArthritis research & therapy2025

Early-onset difficult-to-treat rheumatoid arthritis: proposal of data-driven predictors and temporal threshold.

Pablo Rodriguez-Merlos, Jose Luis Cabrera-Alarcón, Virginia Ruiz-Esquide, Chafik Alejandro Chacur, Raimon Sanmartí, Eugenio De Miguel-Mendieta, Jose María Álvaro-Gracia, Alejandro Balsa, Chamaida Plasencia-Rodríguez, Marta Novella-Navarro

Abstract readObservational Study
In one paragraph

Observational study in Arthritis research & therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Pablo Rodriguez-Merlos *Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Jose Luis Cabrera-Alarcón *Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.
Virginia Ruiz-EsquideRheumatology, Hospital Clinic, Barcelona, Spain.
Chafik Alejandro ChacurRheumatology, Hospital Clinic, Barcelona, Spain.
Raimon SanmartíRheumatology, Hospital Clinic, Barcelona, Spain.
Eugenio De Miguel-MendietaRheumatology, Hospital Universitario La Paz, Madrid, Spain.
Jose María Álvaro-GraciaRheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Alejandro BalsaRheumatology, Hospital Universitario La Paz, Madrid, Spain.
Chamaida Plasencia-Rodríguez *Rheumatology, Hospital Universitario La Paz, Madrid, Spain.
Marta Novella-Navarro *Rheumatology, Hospital Universitario La Paz, Madrid, Spain. mnovellanavarro@gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWhile risk factors for difficult-to-treat rheumatoid arthritis (D2TRA) have been studied in recent years, no studies have determined if there are differences between early and late developers of D2TRA. This study investigates whether patients can be classified by time to D2TRA development and examines risk factors for earlier onset. PATIENTS AND

methodsObservational study involving D2TRA patients whose reason for switching b/tsDMARD therapy was inefficacy (D2TRA-Inneficacy). Demographic data, comorbidities and disease characteristics, acute phase reactants and Disease Activity Score-28 [DAS28-ESR]) at baseline and 6 months after initiation of the first b/tsDMARD, and duration of each treatment were recorded. Using LASSO (Least Absolute Shrinkage and Selection Operator) Cox-regression feature-selection strategy, we identified those factors influencing the time to D2TRA-Inneficacy. DBSCAN clustering was conducted to identify subgroups based on time to D2TRA. Finally, we used ROC and Precision-Recall curves in tandem with the Youden index to establish a cutoff point for differentiating early and late-D2TRA.

resultsOf the 131 patients with D2TRA, 96 (72.7%) were classified as D2TRA-inefficacy. The variables presence of anxiety-depressive syndrome (ADS) at first b/tsDMARD, CRP at 6 months after starting the first b/tsDMARD and age at disease diagnosis were selected based on their contracted scores from the LASSO Cox-regression model, following the criterion of minimizing the cross-validated error. DBSCAN clustering based on selected variables identified three clusters. These clusters, differentiated by time to D2TRA, classified patients into early and late D2TRA groups. Finally, an optimal cut-off point of 44.5 months was determined using the Youden index to distinguish between the two groups.

conclusionIn our cohort, the cut-off time for defining early developers of D2TRA-inefficacy was 44.5 months. The presence of ADS diagnosis, a higher CRP 6 months after the first b/tsDMARD, and being older at diagnosis were predictors of early development of D2TRA.

Indexed as

Antirheumatic AgentsArthritis, RheumatoidAdultAgedFemaleHumansMaleMiddle AgedRisk FactorsTime FactorsAntirheumatic Agents

Identifiers

PMID40684221
PMCPMC12276655

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.