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. 2025 Apr 14;63(2):97-103.
doi: 10.5114/reum/199933. eCollection 2025.

Impact of comorbidities, diabetes, and smoking on sustained outcomes in rheumatoid arthritis: a retrospective study

Zhaklin Apostolova  1 , Tanya Shivacheva  1 , Tsvetoslav Georgiev  1
Affiliations

Impact of comorbidities, diabetes, and smoking on sustained outcomes in rheumatoid arthritis: a retrospective study

Zhaklin Apostolova et al. Reumatologia. .

Abstract

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disease significantly impacting patients' quality of life (QoL) and necessitating complex, long-term treatment. This study aimed to assess the long-term therapeutic outcomes of biologic therapies in a real-world clinical setting, focusing on the achievement and maintenance of low disease activity (LDA) among RA patients, while also investigating factors influencing these outcomes.

Material and methods: A retrospective observational analysis was conducted on 190 RA patients receiving tumor necrosis factor α (TNF-α) or interleukin (IL)-6 inhibitors. Disease activity was evaluated using the Disease Activity Score 28 (DAS28) at baseline, 6 months, and 12 months. Based on the DAS28 with C-reactive protein (DAS28-CRP) values, the disease was categorized into 2 main groups: remission/low activity (target achieved) when the DAS28-CRP value was less than 3.2, and insufficient therapeutic response when the value exceeded 3.2.

Results: The study group consisted of 190 RA patients, predominantly women (85.8%), with a mean age of 58.7 years and a disease duration of 12.5 years. We found that 45.8% of patients achieved single-point LDA, with 39.5% sustaining this response after 12 months. Notably, comorbidities such as diabetes and smoking negatively affected the likelihood of maintaining LDA. Statistical analysis revealed that patients without diabetes had a significantly higher chance of retaining sustained LDA (OR = 0.100; p = 0.014).

Conclusions: These findings emphasize the need for personalized treatment approaches that consider comorbidities and lifestyle factors to enhance long-term therapeutic efficacy in RA management. Consequently, this study highlights the critical importance of ongoing monitoring and individualized strategies to improve outcomes and QoL for patients with RA.

Keywords: biological therapy; comorbidity; rheumatoid arthritis; smoking.

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Conflict of interest statement

The authors declare no conflict of interest.

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