OBJECTIVES: To assess clinical characteristics of RA patients considered suitable for biologic therapy (by their physicians) in comparison to those currently treated with 1stline biologics in the US. METHODS:   A medical chart-review study of RA patients was conducted among physicians (primarily rheumatologists) in hospitals/private practices to collect de-identified data on patient diagnosis, treatment patterns/dynamics and patient symptomatology/disease status. Physicians from the US were screened for duration of practice and patient volume and recruited from a large panel to be geographically representative. Eligible patient charts (>6 biologic patients, > 2 biologic-suitable (and yet biologic-naïve) patients per physician judgment) were randomly selected from a sample of prospective patients visiting each center/practice during the screening period. RESULTS: Ninety-seven physicians abstracted 726 eligible RA patient charts; 378(52%) patients were on their first biologic and 175(24%) patients have never experienced biologic but were considered suitable for one. Mean age was: 1st line-52.8yrs, biologic-suitable-51.5yrs; Female: 1st line-73%, biologic-suitable-76%. Disease severity at diagnosis and current disease severity (both per physician judgment) (mild:moderate:severe) were: 1st line – 6%:74%:14% and 67%:29%:3%, biologic-suitable – 11%,74%, 10% and 25%:66%:9% respectively. Current drug class usage differed between the two groups (1st line/biologic-suitable): non-biological-DMARD (57%/88%), steroids (19%/36%), NSAIDs-COX2-inhibitors (6%/10%), NSAIDs- non-COX2-inhibitors (14%/22%), and analgesics (11%/12%). Key lab measures were (1st line/biologic-suitable): ESR(24.2/40.0 mm/h) and CRP(2.5mg/5.6 dl). Current ACR-scores were (1st line/biologic-suitable): no response(2%/19%), ACR20(12%/36%), ACR50(18%/15%), ACR70(20%/5%), ACR90(26%/1%). Among patients with available data, current HAQ (1st line-0.7, biological-suitable-1.1), DAS28 (1st line-2.5, biological-suitable-4.1), 100mmVAS (1st line-2.3, biological-suitable-4.6), Swollen Joint Count (1st line-2.0, biological-suitable-5.9) and Tender Joint Count (1stline-2.8, biological-suitable-7.0) differed between the patient groups. CONCLUSIONS: Compared to the patients currently treated with 1st line biologic, RA biologic-naïve but suitable patients (per physician judgment) had relatively higher disease burden. Reasons for non-initiation of biologic treatment among ‘biologic-suitable’ patients warrant further investigation to alleviate disease burden.