{"id":"https://openalex.org/W4409434804","doi":"https://doi.org/10.5114/reum/199933","title":"Impact of comorbidities, diabetes, and smoking on sustained outcomes in rheumatoid arthritis: a retrospective study","display_name":"Impact of comorbidities, diabetes, and smoking on sustained outcomes in rheumatoid arthritis: a retrospective study","publication_year":2025,"publication_date":"2025-04-14","ids":{"openalex":"https://openalex.org/W4409434804","doi":"https://doi.org/10.5114/reum/199933","pmid":"https://pubmed.ncbi.nlm.nih.gov/40485943"},"language":"en","primary_location":{"id":"doi:10.5114/reum/199933","doi":"https://doi.org/10.5114/reum/199933","is_oa":true,"landing_page_url":"https://doi.org/10.5114/reum/199933","pdf_url":"https://reu.termedia.pl/pdf-199933-124456?filename=Impact of comorbidities_.pdf","source":{"id":"https://openalex.org/S2755932866","display_name":"Reumatologia/Rheumatology","issn_l":"0034-6233","issn":["0034-6233","2084-9834"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":"https://openalex.org/P4310320332","host_organization_name":"Termedia Publishing House","host_organization_lineage":["https://openalex.org/P4310320332"],"host_organization_lineage_names":["Termedia Publishing House"],"type":"journal"},"license":"cc-by-nc-sa","license_id":"https://openalex.org/licenses/cc-by-nc-sa","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Rheumatology","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://reu.termedia.pl/pdf-199933-124456?filename=Impact of comorbidities_.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5095950376","display_name":"Zhaklin Apostolova","orcid":"https://orcid.org/0009-0000-9309-236X","observed_orcids":["https://orcid.org/0009-0000-9309-236X"]},"institutions":[{"id":"https://openalex.org/I147017597","display_name":"Medical University of Varna","ror":"https://ror.org/03jkshc47","country_code":"BG","type":"education","lineage":["https://openalex.org/I147017597"]},{"id":"https://openalex.org/I4210096790","display_name":"University Hospital St. Marina","ror":"https://ror.org/00t954r14","country_code":"BG","type":"healthcare","lineage":["https://openalex.org/I4210096790"]}],"countries":["BG"],"is_corresponding":false,"raw_author_name":"Zhaklin Apostolova","raw_affiliation_strings":["First Department of Internal Medicine, Faculty of Medicine, University Hospital St. Marina, Medical University - Varna, Bulgaria"],"raw_orcid":"https://orcid.org/0009-0000-9309-236X","affiliations":[{"raw_affiliation_string":"First Department of Internal Medicine, Faculty of Medicine, University Hospital St. Marina, Medical University - Varna, Bulgaria","institution_ids":["https://openalex.org/I147017597","https://openalex.org/I4210096790"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5010269986","display_name":"T. Shivacheva","orcid":"https://orcid.org/0000-0001-7789-4100","observed_orcids":["https://orcid.org/0000-0001-7789-4100"]},"institutions":[{"id":"https://openalex.org/I147017597","display_name":"Medical University of Varna","ror":"https://ror.org/03jkshc47","country_code":"BG","type":"education","lineage":["https://openalex.org/I147017597"]},{"id":"https://openalex.org/I4210096790","display_name":"University Hospital St. Marina","ror":"https://ror.org/00t954r14","country_code":"BG","type":"healthcare","lineage":["https://openalex.org/I4210096790"]}],"countries":["BG"],"is_corresponding":false,"raw_author_name":"Tanya Shivacheva","raw_affiliation_strings":["First Department of Internal Medicine, Faculty of Medicine, University Hospital St. Marina, Medical University - Varna, Bulgaria"],"raw_orcid":"https://orcid.org/0000-0001-7789-4100","affiliations":[{"raw_affiliation_string":"First Department of Internal Medicine, Faculty of Medicine, University Hospital St. Marina, Medical University - Varna, Bulgaria","institution_ids":["https://openalex.org/I147017597","https://openalex.org/I4210096790"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5061796584","display_name":"Tsvetoslav Georgiev","orcid":"https://orcid.org/0000-0002-1652-4648","observed_orcids":["https://orcid.org/0000-0002-1652-4648"]},"institutions":[{"id":"https://openalex.org/I147017597","display_name":"Medical University of Varna","ror":"https://ror.org/03jkshc47","country_code":"BG","type":"education","lineage":["https://openalex.org/I147017597"]},{"id":"https://openalex.org/I4210096790","display_name":"University Hospital St. Marina","ror":"https://ror.org/00t954r14","country_code":"BG","type":"healthcare","lineage":["https://openalex.org/I4210096790"]}],"countries":["BG"],"is_corresponding":true,"raw_author_name":"Tsvetoslav Georgiev","raw_affiliation_strings":["First Department of Internal Medicine, Faculty of Medicine, University Hospital St. Marina, Medical University - Varna, Bulgaria"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"First Department of Internal Medicine, Faculty of Medicine, University Hospital St. Marina, Medical University - Varna, Bulgaria","institution_ids":["https://openalex.org/I147017597","https://openalex.org/I4210096790"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5061796584"],"corresponding_institution_ids":["https://openalex.org/I147017597","https://openalex.org/I4210096790"],"apc_list":null,"apc_paid":null,"fwci":1.2853,"has_fulltext":true,"cited_by_count":2,"citation_normalized_percentile":{"value":0.78478352,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":90,"max":96},"biblio":{"volume":"63","issue":"2","first_page":"97","last_page":"103"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10200","display_name":"Rheumatoid Arthritis Research and Therapies","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10200","display_name":"Rheumatoid Arthritis Research and Therapies","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11616","display_name":"Autoimmune and Inflammatory Disorders Research","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2720","display_name":"Hematology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13026","display_name":"Natural Compounds in Disease Treatment","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2707","display_name":"Complementary and alternative medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/rheumatoid-arthritis","display_name":"rheumatoid arthritis","score":1.0},{"id":"https://openalex.org/keywords/biological-therapy","display_name":"biologic therapy","score":0.8140000104904175},{"id":"https://openalex.org/keywords/tnf-alpha-inhibitors","display_name":"TNF-alpha inhibitors","score":0.8799999952316284},{"id":"https://openalex.org/keywords/il-6-inhibitors","display_name":"IL-6 inhibitors","score":0.8759999871253967},{"id":"https://openalex.org/keywords/low-disease-activity","display_name":"low disease activity","score":0.9639999866485596},{"id":"https://openalex.org/keywords/remission","display_name":"remission","score":0.6790000200271606},{"id":"https://openalex.org/keywords/comorbidity","display_name":"comorbidities","score":0.8149999976158142},{"id":"https://openalex.org/keywords/diabetes-mellitus","display_name":"diabetes mellitus","score":0.9760000109672546},{"id":"https://openalex.org/keywords/smoking","display_name":"smoking","score":0.9990000128746033},{"id":"https://openalex.org/keywords/das28-crp","display_name":"DAS28-CRP","score":0.902999997138977},{"id":"https://openalex.org/keywords/treatment-response","display_name":"treatment response","score":0.6169999837875366},{"id":"https://openalex.org/keywords/quality-of-life","display_name":"quality of life","score":0.777999997138977}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9247353076934814},{"id":"https://openalex.org/C2777575956","wikidata":"https://www.wikidata.org/wiki/Q187255","display_name":"Rheumatoid arthritis","level":2,"score":0.8597918748855591},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.7326355576515198},{"id":"https://openalex.org/C555293320","wikidata":"https://www.wikidata.org/wiki/Q12206","display_name":"Diabetes mellitus","level":2,"score":0.6544286012649536},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.5698386430740356},{"id":"https://openalex.org/C23131810","wikidata":"https://www.wikidata.org/wiki/Q818574","display_name":"Observational study","level":2,"score":0.5520999431610107},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.5110749006271362},{"id":"https://openalex.org/C2779951463","wikidata":"https://www.wikidata.org/wiki/Q7268788","display_name":"Quality of life (healthcare)","level":2,"score":0.42189767956733704},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.3751472234725952},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.0},{"id":"https://openalex.org/C134018914","wikidata":"https://www.wikidata.org/wiki/Q162606","display_name":"Endocrinology","level":1,"score":0.0}],"mesh":[],"locations_count":5,"locations":[{"id":"doi:10.5114/reum/199933","doi":"https://doi.org/10.5114/reum/199933","is_oa":true,"landing_page_url":"https://doi.org/10.5114/reum/199933","pdf_url":"https://reu.termedia.pl/pdf-199933-124456?filename=Impact of comorbidities_.pdf","source":{"id":"https://openalex.org/S2755932866","display_name":"Reumatologia/Rheumatology","issn_l":"0034-6233","issn":["0034-6233","2084-9834"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":"https://openalex.org/P4310320332","host_organization_name":"Termedia Publishing House","host_organization_lineage":["https://openalex.org/P4310320332"],"host_organization_lineage_names":["Termedia Publishing House"],"type":"journal"},"license":"cc-by-nc-sa","license_id":"https://openalex.org/licenses/cc-by-nc-sa","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Rheumatology","raw_type":"journal-article"},{"id":"pmid:40485943","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/40485943","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Reumatologia","raw_type":"Journal Article"},{"id":"pmh:oai:europepmc.org:10951190","doi":null,"is_oa":true,"landing_page_url":"https://www.ncbi.nlm.nih.gov/pmc/articles/12138991","pdf_url":null,"source":{"id":"https://openalex.org/S4306400806","display_name":"Europe PMC (PubMed Central)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1303153112","host_organization_name":"European Bioinformatics Institute","host_organization_lineage":["https://openalex.org/I1303153112"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-nc-sa","license_id":"https://openalex.org/licenses/cc-by-nc-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"Text"},{"id":"pmh:oai:pubmedcentral.nih.gov:12138991","doi":null,"is_oa":true,"landing_page_url":"https://www.ncbi.nlm.nih.gov/pmc/articles/12138991","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-nc-sa","license_id":"https://openalex.org/licenses/cc-by-nc-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Reumatologia","raw_type":"Text"},{"id":"pmh:oai:doaj.org/article:c1e781e8b3a44d4f8ca509d1de5e0315","doi":null,"is_oa":true,"landing_page_url":"https://doaj.org/article/c1e781e8b3a44d4f8ca509d1de5e0315","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Rheumatology, Vol 63, Iss 2, Pp 97-103 (2025)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.5114/reum/199933","doi":"https://doi.org/10.5114/reum/199933","is_oa":true,"landing_page_url":"https://doi.org/10.5114/reum/199933","pdf_url":"https://reu.termedia.pl/pdf-199933-124456?filename=Impact of comorbidities_.pdf","source":{"id":"https://openalex.org/S2755932866","display_name":"Reumatologia/Rheumatology","issn_l":"0034-6233","issn":["0034-6233","2084-9834"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":"https://openalex.org/P4310320332","host_organization_name":"Termedia Publishing House","host_organization_lineage":["https://openalex.org/P4310320332"],"host_organization_lineage_names":["Termedia Publishing House"],"type":"journal"},"license":"cc-by-nc-sa","license_id":"https://openalex.org/licenses/cc-by-nc-sa","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Rheumatology","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":1.0,"display_name":"Good health and well-being"}],"sustainable_development_goals_aurora":[{"id":"https://metadata.un.org/sdg/3","score":0.8700000047683716,"display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W4409434804.pdf","grobid_xml":"https://content.openalex.org/works/W4409434804.grobid-xml"},"referenced_works_count":32,"referenced_works":["https://openalex.org/W1811521558","https://openalex.org/W1969143953","https://openalex.org/W2038593306","https://openalex.org/W2047983384","https://openalex.org/W2081734937","https://openalex.org/W2102746921","https://openalex.org/W2136042500","https://openalex.org/W2152348310","https://openalex.org/W2153737079","https://openalex.org/W2220905733","https://openalex.org/W2322227699","https://openalex.org/W2886829994","https://openalex.org/W2890899067","https://openalex.org/W2908336779","https://openalex.org/W2995100408","https://openalex.org/W3015232330","https://openalex.org/W3016623887","https://openalex.org/W3086300347","https://openalex.org/W3095478473","https://openalex.org/W3133916177","https://openalex.org/W3189817856","https://openalex.org/W3211431331","https://openalex.org/W4211054359","https://openalex.org/W4292014168","https://openalex.org/W4308769923","https://openalex.org/W4311281223","https://openalex.org/W4319986103","https://openalex.org/W4379209177","https://openalex.org/W4386812481","https://openalex.org/W4390051355","https://openalex.org/W4390940890","https://openalex.org/W4403416160"],"related_works":["https://openalex.org/W4381328000","https://openalex.org/W2109147503","https://openalex.org/W2185550546","https://openalex.org/W2103779230","https://openalex.org/W2911339178","https://openalex.org/W2416097977","https://openalex.org/W334096847","https://openalex.org/W2322581019","https://openalex.org/W3141050733","https://openalex.org/W2030936866"],"abstract_inverted_index":{"Objectives":[0],"Rheumatoid":[1],"arthritis":[2],"(RA)":[3],"is":[4],"a":[5,34,151,158,203],"chronic":[6],"autoimmune":[7],"disease":[8,46,110,159],"significantly":[9,204],"impacting":[10],"patients\u2019":[11],"quality":[12],"of":[13,30,44,143,154,161,168,192,207,248],"life":[14],"(QoL)":[15],"and":[16,42,60,97,129,157,186,230,251,257],"necessitating":[17],"complex,":[18],"long-term":[19,27,235],"treatment.":[20],"This":[21],"study":[22,140,243],"aimed":[23],"to":[24,233,254],"assess":[25],"the":[26,40,87,102,109,122,134,190,221,245],"therapeutic":[28,131,236],"outcomes":[29,256],"biologic":[31],"therapies":[32],"in":[33,238],"real-world":[35],"clinical":[36],"setting,":[37],"focusing":[38],"on":[39,68,101],"achievement":[41],"maintenance":[43],"low":[45],"activity":[47,83,118],"(LDA)":[48],"among":[49],"RA":[50,70,145,239],"patients,":[51,146],"while":[52],"also":[53],"investigating":[54],"factors":[55,232],"influencing":[56],"these":[57],"outcomes.":[58],"Material":[59],"methods":[61],"A":[62],"retrospective":[63],"observational":[64],"analysis":[65,196],"was":[66,84,111,125],"conducted":[67],"190":[69,144],"patients":[71,169,199,260],"receiving":[72],"tumor":[73],"necrosis":[74],"factor":[75],"\u03b1":[76],"(TNF-\u03b1)":[77],"or":[78],"interleukin":[79],"(IL)-6":[80],"inhibitors.":[81],"Disease":[82,88],"evaluated":[85],"using":[86],"Activity":[89],"Score":[90],"28":[91],"(DAS28)":[92],"at":[93],"baseline,":[94],"6":[95],"months,":[96],"12":[98,179],"months.":[99,180],"Based":[100],"DAS28":[103],"with":[104,150,173,261],"C-reactive":[105],"protein":[106],"(DAS28-CRP)":[107],"values,":[108],"categorized":[112],"into":[113],"2":[114],"main":[115],"groups:":[116],"remission/low":[117],"(target":[119],"achieved)":[120],"when":[121,133],"DAS28-CRP":[123],"value":[124,135],"less":[126],"than":[127],"3.2,":[128],"insufficient":[130],"response":[132,177],"exceeded":[136],"3.2.":[137],"Results":[138],"The":[139],"group":[141],"consisted":[142],"predominantly":[147],"women":[148],"(85.8%),":[149],"mean":[152],"age":[153],"58.7":[155],"years":[156],"duration":[160],"12.5":[162],"years.":[163],"We":[164],"found":[165],"that":[166,198,227],"45.8%":[167],"achieved":[170],"single-point":[171],"LDA,":[172],"39.5%":[174],"sustaining":[175],"this":[176,242],"after":[178],"Notably,":[181],"comorbidities":[182,229],"such":[183],"as":[184],"diabetes":[185,201],"smoking":[187],"negatively":[188],"affected":[189],"likelihood":[191],"maintaining":[193],"LDA.":[194],"Statistical":[195],"revealed":[197],"without":[200],"had":[202],"higher":[205],"chance":[206],"retaining":[208],"sustained":[209],"LDA":[210],"(OR":[211],"=":[212,215],"0.100;":[213],"p":[214],"0.014).":[216],"Conclusions":[217],"These":[218],"findings":[219],"emphasize":[220],"need":[222],"for":[223,259],"personalized":[224],"treatment":[225],"approaches":[226],"consider":[228],"lifestyle":[231],"enhance":[234],"efficacy":[237],"management.":[240],"Consequently,":[241],"highlights":[244],"critical":[246],"importance":[247],"ongoing":[249],"monitoring":[250],"indivi\u00addualized":[252],"strategies":[253],"improve":[255],"QoL":[258],"RA.":[262]},"counts_by_year":[{"year":2026,"cited_by_count":1},{"year":2025,"cited_by_count":1}],"updated_date":"2026-09-26T08:19:03.415552","created_date":"2025-10-10T00:00:00"}