Impact of biological and targeted synthetic disease-modifying anti-rheumatic drug therapy on disease activity and health-related quality of life in Egyptian patients with rheumatoid arthritis

Abstract Background Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent joint inflammation, often resulting in significant functional impairment and reduced health-related quality of life (HRQoL). Biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) have substantially transformed RA management. Objectives To evaluate the impact of b/tsDMARD therapy on disease activity and HRQoL in a cohort of Egyptian RA patients unresponsive to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and to explore factors influencing baseline HRQoL. Methods This ambispective (prospective and retrospective) cohort study included 78 Egyptian RA patients. Patients met the 2010 ACR/EULAR RA classification criteria and received b/tsDMARDs after conventional treatment failure. Disease activity was assessed using the Clinical Disease Activity Index (CDAI), while HRQoL was evaluated using the Arabic version of the RAND short form (SF)-36 health survey at baseline and six months post-treatment. Clinical, laboratory, and sociodemographic data were also analyzed. Results CDAI scores significantly decreased from 27 ± 12 to 6 ± 3 ( p < 0.001), with marked reductions in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels ( p < 0.001). Significant improvements were observed across all SF-36 domains, with physical and mental component scores increasing from 20 to 81 and 27 to 89, respectively ( p < 0.001). The median time from disease onset to b/tsDMARD initiation was 6.5 years. Longer treatment delays were associated with poorer HRQoL at six months, including physical functioning, vitality, body pain, general health, and physical and mental component scores. Baseline HRQoL was influenced by employment status and comorbidities, while older age was associated with poorer physical functioning. Higher baseline disease activity was associated with poorer HRQoL. Conclusion Treatment with b/ts DMARD therapy significantly improved disease activity and HRQoL in a cohort of Egyptian RA patients. However, longer treatment delay was associated with poorer outcomes.