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Nyoman Kertia
Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran, Kesehatan Masyarakat, Dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
Biochemistry, Genetics & Molecular Biology Chemistry Decision Sciences, Operations Research & Management Education Environmental Science Health Professions Immunology & microbiology Materials Science & Nanotechnology Medicine & Pharmacology Neuroscience Nursing Public Health Other

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Journal : Universa Medicina

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Predictors of persistent high disease activity after methotrexate treatment in rheumatoid arthritis patients Paramaiswari, Ayu; Kertia, Nyoman; Achadiono, Deddy; Sinarta, Armin; Nugroho, Dhite
Universa Medicina Vol. 44 No. 2 (2025)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2025.v44.141-151

Abstract

Background Methotrexate (MTX) is the firstline therapy for rheumatoid arthritis (RA). However, 30–40% of RA patients exhibit poor response. Identifying early factors associated with persistent disease activity is critical to guide treatment. This study aimed to identify predictors of persistent high disease activity (DAS28-ESR >3.2) after six months of MTX therapy in RA patients. Methods A retrospective cohort study was conducted involving 204 RA patients who had completed six months of MTX therapy. The primary outcome was DAS28-ESR score at six months. Independent variables included baseline erythrocyte sedimentation rate (ESR), cumulative doses of MTX and low-dose methylprednisolone (LDM), and rheumatoid factor (RF) status. Simple and multiple logistic regression was used to analyze the data.  Results Significant differences in ESR and cumulative MTX dose were observed between low and high disease activity groups. Multivariate analysis identified four independent predictors of persistent high disease activity (DAS28-ESR >3.2) after six months of MTX therapy: disease duration >11 months (AOR =0.45; 95% CI 0.23–0.89; p=0.025); age at onset >50 years (AOR 0.48; 95% CI 0.24–0.94; p=0.038); cumulative MTX dose >85 mg (AOR 4.75; 95% CI 1.55–14.64; p=0.006); ESR >66 mm/hr (AOR 2.32; 95% CI 1.11–4.89; p=0.026).  Conclusion Greater cumulative methotrexate dose (>85 mg) was the most influential predictor of persistent high disease activity (DAS28-ESR >3.2) after six months of MTX therapy in RA patients. These findings may assist clinicians in identifying patients at risk for poor MTX response and support timely therapeutic adjustments.
Co-Authors Abdul Khairul Rizki Purba Mustofa Indwiani Astuti Achadiono, Deddy Achadiono, Dedy Nurwachid Adi Dharma, Ignasius Agus Setiyono Ahmad Husain Asdie Ahmad Husain Asdie Ahmad Husain Asdie Arif Nurrochmad Arif Prassetyo Arina Syarifa Fadlilah Asdie, Achmad Husain Ayu Paramaiswari Ayu Paramaiswari Baiq R Rhadianaa Bambang Udji Djoko Rianto Bambang Udji Djoko Riyanto, Bambang Udji Djoko Cleopas Martin Rumende Danang ., Danang Deddy Nur Wachid Deddy Nur Wachid Achadiono Deddy Nur Wachid Akhadiono Deddy Wachid Achadiyono Dewa Ayu G. N. Dewa Ayu G. N., Dewa Ayu Dyah Ariani Perwitasari Dyah Aryani Perwitasari Ema Madyaningrum Endang Mahati Eny Catur, Eny F, Melani Farah Nuriannisa Gede Kambayana Gunawan, I Made Alit Hangga Harinawantara Harry Isbagio Haslinda Haslinda Haslinda Haslinda, Haslinda Heru Yulianto I Dewa Putu Pramantara I Made Alit Gunawan I Made Alit Gunawan Ika Puspitaningrum Imono A.D., Imono Indwiani Astuti Irwan Supriyanto Kartyanto, Adhita Khasana, Tri Mei Krishnan, P N Lily Arsanti Lestari Lisnawati Rachmadi M. Marsetyawan Mae Sri Hartati Wahyuningsih Maria Caecilia Nanny Setiawati Maria Caecilia Setiawati Marsetyawan -, Marsetyawan Marsetyawan Marsetyawan Marsetyawan Marsetyawan Mohammad Robikhul Ikhsan Mufrod ., Mufrod Mustika Muthaharah Mustika Muthaharah mustika muthaharah muthaharah, mustika N. Setiawati, M. Caecilia Nastiti Hemas M. Nastiti Hemas M., Nastiti Hemas Nugroho, Dhite Nunu N Madjid Nur Arfian Nur Mahdi Nurrochmad, Arif P N Krishnan Poerwono Rahardjo Pratiwi, Woro Rukmi Probosuseno Probosuseno Probosuseno Probosuseno, Probosuseno R. A.T. Kuswardhani Rianto Setiabudy Rochmach, Wasilah Ronny T Wirasto Sinarta, Armin SRI SETIYARINI, SRI Srinalesti Mahanani, Srinalesti Sugeng Sugeng Supanji, Supanji Susini R Sari Tri Mei Khasana W.N., Meika Wachid, Deddy Nur Wasilah Rochmah Wasilah Rochmah Wasilah Rochmah Wibowo, Suryo Anggoro Kusumo Widhiarta, Putu Raka Wiwekananda, Ketut Shri Satya Wiwin Lismidiati Yogiswara, Komang Satvika Yolanda Dyah Kartika Yuliani, Kartika Yulyani Werdhiningsih Z, Ikawati Zulies Ikawati