Korean J Intern Med.  2020 Jan;35(1):231-239. 10.3904/kjim.2018.137.

Simplified disease activity changes in real-world practice: a nationwide observational study of seropositive rheumatoid arthritis patients with moderate-to-high disease activity

  • 1Division of Rheumatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
  • 2Division of Rheumatology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
  • 3Division of Rheumatology, Konkuk University Medical Center, Seoul, Korea
  • 4Division of Rheumatology, Kyung Hee University Hospital, Seoul, Korea
  • 5Division of Rheumatology, Korea University Ansan Hospital, Ansan, Korea
  • 6Division of Rheumatology, Daegu Catholic University Medical Center, Daegu, Korea
  • 7Division of Rheumatology, Pusan National University Hospital, Busan, Korea
  • 8Division of Rheumatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 9Division of Rheumatology, Seoul National University Hospital, Seoul, Korea
  • 10Division of Rheumatology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
  • 11Division of Rheumatology, Gangnam Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
  • 12Division of Rheumatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
  • 13Division of Rheumatology, Ajou University Hospital, Suwon, Korea
  • 14Division of Rheumatology, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 15Division of Rheumatology, Ulsan University Hospital, Ulsan, Korea
  • 16Division of Rheumatology, Eulji University Hospital, Daejeon, Korea
  • 17Division of Rheumatology, Inha University Hospital, Incheon, Korea
  • 18Division of Rheumatology, Chonnam National University Hospital, Gwangju, Korea
  • 19Division of Rheumatology, Chonbuk National University Hospital, Jeonju, Korea
  • 20Division of Rheumatology, Jeju National University Hospital, Jeju, Korea
  • 21Division of Rheumatology, Chung-Ang University Hospital, Seoul, Korea
  • 22Division of Rheumatology, Hanyang University Guri Hospital, Guri, Korea
  • 23Division of Rheumatology, Inje University Haeundae Paik Hospital, Busan, Korea
  • 24Division of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea


The objective of this study was to compare changes in the simplified disease activity index (SDAI) between biologic (b) and conventional (c) disease-modifying antirheumatic drugs (DMARD) users with seropositive rheumatoid arthritis (RA) in daily clinical practice. Methods: This was a nationwide multicenter observational study. Patients who had three or more active joint counts and abnormal inf lammatory marker in blood test were enrolled. The selection of DMARDs was determined by the attending rheumatologist. Clinical parameters, laboratory findings, and Health Assessment Questionnaire (HAQ) scores were obtained at baseline and at 6 and 12 months. Serial SDAI changes and clinical remission rate at 6 and 12 months were assessed. Results: A total of 850 patients participated in this study. The mean baseline SDAI score in bDMARD group was higher than that in cDMARD group (32.08 ± 12.98 vs 25.69 ± 10.97, p < 0.0001). Mean change of SDAI at 12 months was –19.0 in the bDMARD group and –12.6 in the cDMARD group (p < 0.0001). Clinical remission rates at 12 months in bDMARD and cDMARD groups were 15.4% and 14.6%, respectively. Patient global assessment and HAQ at 12 months were also significantly improved in both groups. Multivariate logistic regression showed that baseline HAQ score was the most notable factor associated with remission. Conclusions: There was a significant reduction in SDAI within 12 months after receiving DMARDs in Korean seropositive RA patients irrespective of bDMARD or cDMARD use in real-world practice. Clinical remission was achieved in those with lower baseline HAQ scores.


Arthritis, rheumatoid; Antirheumatic agents; Biological therapy
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