Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Ann Rheum Dis. 2018 Jul;77(7):966-969. doi: 10.1136/annrheumdis-2017-212862. Epub 2018 Mar 27.
While biologic disease-modifying antirheumatic drugs (bDMARDs) have transformed outcomes of people with rheumatoid arthritis (RA), a proportion of patients are refractory to multiple bDMARDs. Definitions of refractory RA thus far have been arbitrary, and outcome data and impact of such cohorts remain limited. Extrapolation from randomised controlled trial and some real-life data suggest approximately 20% progress onto a third bDMARD with a more modest proportion failing additional bDMARDs. This viewpoint discusses an opinion of refractory RA disease and proposes key principles to accurately identify refractory cohorts. These include demonstrating presence of persistent inflammation despite multiple therapies and acknowledging development of antidrug antibody. Potential basis of refractory disease is summarised, and suggestions for an initial approach in the future evaluation of refractory disease are offered. Specific investigation of refractory RA disease is necessary to inform the clinical need and provide a basis for robust investigation of underlying mechanisms.
虽然生物制剂疾病修饰抗风湿药物（bDMARDs）改变了类风湿关节炎（RA）患者的结局，但仍有一部分患者对多种 bDMARDs 产生抵抗。迄今为止，RA 抵抗的定义是任意的，此类患者队列的数据和影响仍然有限。来自随机对照试验和一些真实世界数据的推断表明，约有 20%的患者进展到第三种 bDMARD，而更多的患者在使用额外的 bDMARD 时会失败。本文观点讨论了 RA 抵抗疾病的观点，并提出了准确识别抵抗性患者群体的关键原则。这些原则包括：尽管采用了多种治疗方法，但仍存在持续的炎症；并承认抗药物抗体的产生。总结了难治性疾病的潜在基础，并为未来难治性疾病的评估提供了初步方法的建议。有必要对难治性 RA 疾病进行具体的研究，以了解临床需求，并为深入研究潜在机制提供依据。
