Fig. 3

A Agreement and Cohen’s κ of D2T-RA definition. B Sankey diagram showing the fluctuations of pD2T-RA and eD2T-RA patients. A Analysis of agreement and Cohen’s κ of D2T-RA definition among patients at different time points during the 12 months of observation. B Sankey diagram showing the fluctuations of D2T-RA state of pD2T-RA (red links) and eD2T-RA patients (yellow links). Notably, the red links almost uniformly flow through the D2T-RA nodes from t0 to t-12 with few, scattered losses. On the other hand, the oscillations of yellow links between the D2T-RA and the non-D2T-RA status are more frequent and more conspicuous along the 12 months follow up (never D2T-RA patients were excluded from the analysis). Abbreviations. D2T-RA: difficult-to-treat rheumatoid arthritis; pw: pairwise; pD2T-RA: persistent difficult-to-treat; eD2T-RA: episodic difficult-to-treat