Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
Arthritis Care Res (Hoboken). 2022 Mar;74(3):468-477. doi: 10.1002/acr.24498. Epub 2022 Feb 12.
To identify predictors of response to immunosuppressive therapy after 1 year, with a focus on autoantibodies, in patients newly diagnosed with idiopathic inflammatory myopathies (IIM) followed longitudinally in an electronic registry.
We assessed the association between autoantibody-defined groups and improvement according to American College of Rheumatology/European Alliance of Associations for Rheumatology 2016 response criteria.
We identified 156 patients; of those, 111 (71%) were positive for any autoantibody tested, 90% received glucocorticoid treatment at baseline, and 78% received immunosuppressive drugs at some follow-up point. After 1 year from the index date, the overall median improvement score was 27.5 (interquartile range 10-51). No differences were observed in the total improvement score between the autoantibody-defined groups. Overall, 62% of patients (n = 96) showed a minimal response, 38% (n = 60) achieved a moderate response, and 19% (n = 30) achieved a major response. Regarding the different levels of response, dermatomyositis-specific autoantibodies were associated with a moderate response versus the seronegative group (reference), odds ratio 4.12 (95% confidence interval 1.2-16.5). In addition, dysphagia, time from symptom onset to diagnosis, and initial glucocorticoid dose were significant predictors of response after 1 year of follow-up.
Patients with DM-specific autoantibodies achieved better levels of response compared to other autoantibody-defined groups. Dysphagia, a shorter time span from symptom onset to diagnosis, and intensive initial immunosuppressive treatment were associated with a higher response rate after 1 year of pharmacologic treatment from the index date, regardless of autoantibody status.
通过对电子病历中进行纵向随访的新诊断特发性炎性肌病（IIM）患者进行研究，确定其在经过 1 年免疫抑制治疗后应答的预测因素，重点关注自身抗体。
我们评估了自身抗体定义的组别与根据美国风湿病学会/欧洲抗风湿病联盟 2016 年应答标准的改善之间的关联。
我们共纳入了 156 名患者；其中 111 名（71%）患者的任何检测到的自身抗体均为阳性，90%的患者在基线时接受糖皮质激素治疗，78%的患者在随访过程中的某个时间点接受免疫抑制药物治疗。从索引日期起 1 年后，整体中位数改善评分 27.5（四分位距 10-51）。在自身抗体定义的组别中，总体改善评分无差异。总的来说，62%（n=96）的患者表现为最小应答，38%（n=60）为中度应答，19%（n=30）为主要应答。关于不同水平的应答，皮肌炎特异性自身抗体与与血清阴性组（参考）相比，中度应答的几率比为 4.12（95%置信区间 1.2-16.5）。此外，吞咽困难、从症状出现到诊断的时间和初始糖皮质激素剂量是 1 年后应答的显著预测因素。
与其他自身抗体定义的组别相比，具有 DM 特异性自身抗体的患者的应答水平更好。吞咽困难、从症状出现到诊断的时间较短以及初始免疫抑制治疗强度与从索引日期开始的 1 年药物治疗后更高的应答率相关，而与自身抗体状态无关。
