ArticleBMJ open2026
Associations between achieving treatment targets and functional and economic outcomes in patients with rheumatoid arthritis: retrospective cohort analyses of BRASS registry data.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis study evaluated the associations between achieving treatment goals and patient-reported outcomes (PROs) and healthcare resource utilisation (HCRU) among patients with rheumatoid arthritis (RA) on advanced treatment.
designRetrospective cohort analyses of deidentified data from an established registry.
settingUS-based single-centre registry between 2003 and 2024.
participantsData from patients with RA in the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study registry were analysed using multivariable regression analyses. Patients were classified into four groups based on Clinical Disease Activity Index (CDAI) scores at baseline and 1 year (consistently at/not at target, gain or lose target). Patients who were consistently at target were further classified into remission, very low disease activity (LDA) and LDA subgroups. PRIMARY AND SECONDARY OUTCOME MEASURES: PROs (Multidimensional Health Assessment Questionnaire (MDHAQ) overall, pain, fatigue scores) and HCRU (surgery rates, durable medical equipment (DME) use) were assessed over 2 years.The primary endpoint compared MDHAQ PROs and surgery and DME HCRU among the four primary groups. The secondary endpoint assessed the association between maintaining LDA and achieving remission at follow-up with PROs and HCRU.
resultsAmong 637 patients with CDAI data, 257 (40%) had LDA at baseline; 57 (22%) lost target at 1 year. Of 380 (60%) patients with CDAI >10 at baseline, 115 (30%) attained LDA. Patients not attaining LDA had higher surgery risk, DME use and MDHAQ scores. Of 200 (31%) patients with LDA at baseline and 1 year, 89 (45%) achieved remission, 79 (40%) very LDA and 32 (16%) LDA. Remission was associated with reduced DME use (adjusted OR (AOR) 5.4 (95% CI 1.9 to 15.4) at year 1 and AOR 4.4 (95% CI 1.7 to 11.1) at year 2) and improved MDHAQ scores compared with LDA (overall unadjusted mean 0.07 vs 0.5 at year 1 and 0.09 vs 0.4 at year 2; p<0.001), with no differences in surgery rates (AOR 1.9 (95% CI 0.7 to 5.6) at year 1 and AOR 1.9 (95% CI 0.8 to 4.4) at year 2).
conclusionsAchieving and maintaining LDA is challenging for patients with RA but leads to better functional outcomes and reduced DME use. Patients who achieve remission have further improvements.
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