An ongoing long-term prospective cohort study is conducted by our team, that is dedicated to recruit patients with RA, to identify the development of clinical, biomedical, histopathological and imaging biomarkers for the diagnosis and prognosis of difficult-to-treat RA, and RA-related complications / comorbidities including sarcopenia, CVD, malignancies, specific infections (especially tuberculosis, herpes zoster, and HBV reactivation), and to evaluate their impact on the long-term prognosis of RA.

To improve the prognosis of RA, this study includes the following objectives:

1. Construct a useful database to explore the secular dynamic progress of RA, including RA progression and complications (e.g., sarcopenia, CVD, malignancies, infections), as well as to improve our understanding of the life-course factors affecting the process that will facilitate future research activities.
2. Identify the potential biomarkers (clinical, biochemical, histopathological, and imaging markers) to develop multimodal models predicting outcomes in high-risk RA subgroups like difficult-to-treat RA.
3. Develop the related multi-modal prediction models with clinical, biomedical and imaging variables to improve the diagnosis and prognosis of RA.

Inclusion Criteria:

• Patients aged 18 years or older and diagnosed with RA according to 1987 ACR or 2010 ACR / EULAR classification criteria

Exclusion Criteria:

• Patients do not plan to receive long-term healthcare at SYSMH, PYCH or SS-SYSMH
• Patients unable to provide written informed consent

The patients with RA will be consecutively recruited during 2024 and 2033 from the Department of Rheumatology, Sun Yat-sen Memorial Hospital (SYSMH) of Sun Yat-sen University, The Affiliated Panyu Central Hospital (PYCH) of Guangzhou Medical University in Guangzhou, and ShenShan Medical center, Memorial Hospital of Sun Yat-sen University (SS-SYSMH) in Shanwei, P.R China. The inclusion criteria for this study are as follows: 1) diagnosis with RA according to 1987 ACR [41] or 2010 ACR/EULAR classification criteria [42]; 2) age ≥ 18 years old. The exclusion criteria are as follows: 1) patients do not plan to receive long-term healthcare at SYSMH, PYCH or SS-SYSMH; 2) unable to provide written informed consent.