Objective: To describe the pattern of DMARD used, treatment outcome, and factor affecting treatment outcome in RA patients treated at rheumatology clinic, Srinagarind Hospital, KhonKaen Universtiy.
Materials and Methods: Cross-sectional study was performed on data base of 359 RA patients who met 1987 ACR or 2010 Rheumatoid Arthritis Classification criteria for RA. We included patients older than 18 years-old who has been treated with >1 DMARDs for at least 1 year. Demographic data, co-morbidities, articular and extra-articular manifestations, current DMARDs used, DMARDs used during achieving treatment target, Disease activity score of 28 joints (DAS 28), laboratory and radiographic results was collected from RA database.
Results: Mean age of onset was 45 (SD+12.8) years with median disease duration of 12.4 (IQR 7.3 to 17.5) years. 338
(94.1%) of overall RA patients received conventional synthetic DMARDs [csDMARD], meanwhile based on reimbursement
type, 9 out of 202 (4.45%) received biologic DMARDs [bDMARDs]. The most frequently use DMARD was methotrexate [MTX]. Currently 155 (43.2%) out of 359 were treated with 2 DMARDs, while 148 (41.2%) had DMARD monotherapy. Disease activity among patients received only csDMARD(s) was scored as low (<3.2), moderate (>3.2 to 5.1), and high (>5.1) at the proportion of 44.4, 45.8, and 8.2% respectively. Number of patients who had received and recieved bDMARDs was small (21 cases). Among these, 76.2% were good responders of which 50% achieved treatment target, and (25%) had drug free remission. Only 4.5% needed long term bDMARDs of which 38.1% had low disease activity [LDA] and 61.9% had moderate DAS. Low dose corticosteroid [LDCS] was overall prescribed in 63.5%. In csDMARDs group, its use was related with higher DAS; 52.3, 69.7, and 82.1% among patients having low, moderate, and high DAS. In patients who achieved treatment target, 61.8% had sustained remission/LDA >1 year. Factors associated with achieving target were history of having remission, induction with MTX, and early remission after DMARDs initiation.
Conclusion: In this RA cohort, 94.1% received only csDMARD and 4.45% received long term bDMARD. 43.7% of csDMARD group and 38.1% of bDMARD group currently achieved treatment target. None of bDMARD group had high DAS. LDCS was overall prescribed in 63.5%. The factors associated with current LDA in RA patients were history of having remission, induction with MTX, and achieving remission within the first year after DMARDs initiation.

Keywords: DMARDs, Outcome, Rheumatoid arthritis