难以治疗的类风湿关节炎患者的特征：一项描述性回顾性队列研究。

IF 2 4区医学 Q3 RHEUMATOLOGY

Advances in Rheumatology Pub Date : 2024-08-06 DOI:10.1186/s42358-024-00396-6

Wen Qi, Antoine Robert, Narcisse Singbo, Lucie Ratelle, Paul R Fortin, Louis Bessette, Jacques P Brown, Laëtitia Michou

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引用次数: 0

摘要

背景：2021年，EULAR工作组公布了难以治疗的类风湿关节炎（D2T RA）的定义。根据 EULAR 的定义，我们目前对 D2T 类风湿关节炎的了解基于欧洲和亚洲的队列，北美队列尚未公布。本研究的目的是比较对晚期治疗反应良好的D2T RA患者和非D2T RA患者，并描述他们在大学医疗中心患者队列中的演变情况：这是一项回顾性单中心研究，研究对象是至少使用过一种生物制剂或靶向合成DMARD（b/tsDMARD）的所有成人RA患者的病历。D2T RA组是根据EULAR对D2T RA的定义定义的。非 D2T RA 组的定义是对 b/tsDMARD 反应良好的患者，他们在使用 1 或 2 种 b/tsDMARD 作用机制后，病情活动性低或缓解至少一年。我们比较了患者的合并症和 b/tsDMARD 使用史。我们计算了描述性统计和比例。采用卡普兰-梅耶尔分析和对数秩检验来估计和比较中位生存期：在417名患者中，101人（24%）为D2T RA，316人（76%）为非D2T RA。D2T RA 组患者年龄略低（63 ± 9 岁对 65 ± 12 岁，P = 0.045），更有可能同时伴有非炎症性疼痛（28% 对 8%，P = 0.045）：与 b/tsDMARD 反应良好的非 D2T RA 患者相比，D2T RA 患者更容易并发非炎症性疼痛。即使是 D2T RA 患者，也可以采取节省类固醇的策略。未来的前瞻性研究可能会比较 JAK 抑制剂和其他作用机制对 D2T RA 的影响。

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Characteristics of patients with difficult-to-treat rheumatoid arthritis: a descriptive retrospective cohort study.

Background: In 2021, an EULAR task force published a definition of difficult-to-treat rheumatoid arthritis (D2T RA). Our current knowledge of D2T RA with the EULAR definition is based on European and Asian cohorts, and no North American cohort has yet to be published. The aim of this study was to compare D2T RA patients to non-D2T RA who are good responders to advanced therapy, and to describe their evolution in an university health center patient cohort.

Methods: This is a retrospective single centre study of the medical records of all adults with RA on at least one biologic or target synthetic DMARD (b/tsDMARD). D2T RA group was defined according to the EULAR definition of D2T RA. The non-D2T RA group was defined as a b/tsDMARD good responder who had low-disease activity or remission for at least one year on 1 or 2 b/tsDMARD mechanism of action. We compared the patients' comorbidities, and history of b/tsDMARD use. Descriptive statistics and proportions were calculated. Kaplan-Meier analysis with log-rank test was used to estimate and compare median survival.

Results: Among the 417 patients, 101 (24%) were D2T RA and 316 (76%) were non-D2T RA. D2T RA group was slightly younger (63 ± 9 years versus 65 ± 12 years, p = 0.045), more likely to have concomitant non-inflammatory pain (28% versus 8%, p < 0.0001) and to discontinue at least one b/tsDMARD due to intolerance (39% versus 10%, p < 0.0001). In the D2T RA group, JAK inhibitors were associated with longer drug continuation when used as the third b/tsDMARD. Fewer patients were using corticosteroid at their most recent follow-up in this Canadian cohort compared to others (16% versus from 29 to 74%).

Conclusion: Concomitant non-inflammatory pain was more prevalent in D2T RA patients compared to b/tsDMARD good responder non-D2T RA patients. Steroid-sparing strategies is possible even in D2T RA patients. Future prospective research may compare JAK inhibitors with other mechanisms of action in D2T RA.

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来源期刊

Advances in Rheumatology Medicine-Rheumatology

CiteScore

4.00

自引率

4.30%

发文量

审稿时长

53 weeks

期刊介绍： Formerly named Revista Brasileira de Reumatologia, the journal is celebrating its 60th year of publication. Advances in Rheumatology is an international, open access journal publishing pre-clinical, translational and clinical studies on all aspects of paediatric and adult rheumatic diseases, including degenerative, inflammatory and autoimmune conditions. The journal is the official publication of the Brazilian Society of Rheumatology and welcomes original research (including systematic reviews and meta-analyses), literature reviews, guidelines and letters arising from published material.