{
  "abstract": "Objectives To assess the effectiveness of switching biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in patients with low-inflammatory difficult-to-treat rheumatoid arthritis (D2T RA).Methods Using the multicentre FIRST registry, we identified D2T RA between August 2013 and March 2024. Low-inflammatory D2T RA was defined as a swollen 28-joint count ≤1 and C-reactive protein <10 mg/L. In the low-inflammatory D2T RA group, we compared those who underwent b/tsDMARD switching (the switch group) with the non-switch group. The primary outcome was the 6-month change in Clinical Disease Activity Index (CDAI).Results Among 3519 patients, 457 fulfilled the D2T RA criteria, and 173 were low-inflammatory D2T RA. Compared with inflammatory D2T RA, these patients had a shorter disease duration (127.4 vs 146.4 months), lower methotrexate (9.2 vs 10.5 mg/week) and glucocorticoid doses (4.3 vs 5.2 mg/day), and higher rates of fibromyalgia (2.9% vs 1.4%) and psychological disorders (5.2% vs 1.8%). The proportion receiving b/tsDMARD switching was lower in low-inflammatory than in inflammatory D2T RA (29/173 (16.8%) vs 217/284 (76.4%)). In the propensity score-matched analysis, the switch group (n=15) showed greater improvements in CDAI and pain than the non-switch group (n=30) (−6.6 vs −2.2, −15.3 vs −3.4, both p<0.05). Even among patients with low-grade sonographic activity (greyscale ≤1, power Doppler=0), b/tsDMARD switching improved CDAI (16.8 to 9.7).Conclusions A subset of patients with low-inflammatory D2T RA may benefit from b/tsDMARD switching, indicating that low-inflammatory status alone should not preclude consideration of treatment intensification.",
  "authors": [
    {
      "affiliations": [
        "First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Hidenori Sakai"
    },
    {
      "affiliations": [
        "Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Koshiro Sonomoto"
    },
    {
      "affiliations": [
        "First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Shingo Nakayamada"
    },
    {
      "affiliations": [
        "First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Masanobu Ueno"
    },
    {
      "affiliations": [
        "First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Atsushi Nagayasu"
    },
    {
      "affiliations": [
        "First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Takafumi Aritomi"
    },
    {
      "affiliations": [
        "Department of Medical Informatics and Management, Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Hiroaki Tanaka"
    },
    {
      "affiliations": [
        "First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Satoshi Kubo"
    },
    {
      "affiliations": [
        "Department of Molecular Targeted Therapeutics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Ippei Miyagawa"
    },
    {
      "affiliations": [
        "Department of Molecular Targeted Therapeutics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Yasuyuki Todoroki"
    },
    {
      "affiliations": [
        "First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Yurie Satoh-Kanda"
    },
    {
      "affiliations": [
        "First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Yuya Fujita"
    },
    {
      "affiliations": [
        "First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Ryuichiro Kanda"
    },
    {
      "affiliations": [
        "Department of Molecular Targeted Therapeutics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Yoshiya Tanaka"
    }
  ],
  "title": "Real-world effectiveness of b/tsDMARD switching in low-inflammatory difficult-to-treat rheumatoid arthritis: insights from the FIRST registry",
  "uid": "8d5b9f7c-0455-5423-a72f-898ac000bea1"
}