Treatment Outcomes and Associated Factors among Patients with Rheumatoid Arthritis: A Multicenter Cross-Sectional Study in Northwest Amhara, 2024

Abstract

ntroduction: Clinical remission and low disease activity are desirable and achievable goals in the treatment of rheumatoid arthritis. Many patients have uncontrolled outcomes due to various factors influencing disease activity. Identifying the factors contributing to uncontrolled outcomes is essential for optimizing treatment strategies and improving outcomes. Objectives: This study aimed to assess treatment outcomes and associated factors among patients with rheumatoid arthritis at selected comprehensive specialized hospitals in Northwest Amhara. Methods: A cross-sectional study was conducted from June 1 to August 30, 2024, utilizing an interview-administered questionnaire and chart reviews. Systematic random sampling was employed to select 297 patients. Data entry was performed using EpiData version 4.6, while analysis was conducted using SPSS (Statistical Package for the Social Sciences) version 27. Results were presented in the form of text, tables, and graphs. Bivariate and multivariable binary logistic regression analyses were performed. Variables with a p-value < 0.2 in the bivariate analysis were included in the multivariable model. Factors significantly associated with uncontrolled outcomes were identified at a p-value < 0.05 in the multivariable analysis. Results: In this study, 57.2% and 68.4% of patients had uncontrolled outcomes based on the Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3), respectively. The use of a single conventional synthetic disease-modifying antirheumatic drug (csDMARD) with adjusted odds ratio [AOR] = 4.31, 95% confidence interval [CI]: 1.72, 10.82), csDMARD-only regimens (AOR = 2.90, 95% CI: 1.34, 6.30), female sex (AOR = 3.32, 95% CI: 1.60, 6.94), rheumatoid factor positivity (AOR = 5.54, 95% CI: 2.61, 11.75), and medication nonadherence (AOR = 5.14, 95% CI: 2.63, 10.03) were significantly associated with uncontrolled outcomes as measured by CDAI. Conclusions: A high proportion of patients had uncontrolled outcomes. Female sex, rheumatoid factor positivity, single csDMARD, csDMARD-only regimens, and nonadherence were all factors in uncontrolled outcomes. Routine monitoring, personalized treatment plans, and comprehensive patient education are essential to reducing uncontrolled outcomes.