Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Rheumatology (Oxford). 2021 Nov 3;60(11):5247-5256. doi: 10.1093/rheumatology/keab209.
The aim of this study was to investigate the clinical characteristics of patients with difficult-to-treat RA (D2T RA) and the usefulness of switching to drugs with different modes of action in real-world.
We reviewed all consecutive patients with RA treated at Keio University Hospital between 2016 and 2017 with a definition of D2T RA. We analysed clinical characteristics and evaluated the usefulness of changing drugs according to mode of action.
Among 1709 patients with RA, 173 (10.1%) were D2T RA. The reason for the D2T RA was multi-drug resistance in 59 patients (34.1%), comorbidity in 17 (9.8%), and socio-economic reasons in 97 (56.1%). The multi-drug-resistance group had significantly higher tender joint count and evaluator global assessment than the other groups, despite receiving the most intensive treatment. The comorbidity group showed a significantly older age and higher rheumatic disease comorbidity index. Although changing the drug to another with a different mode of action was useful, the proportion of patients who achieved remission or low disease activity decreased as the number of switches increased.
Of the patients with RA, 10.1% were still difficult to treat in clinical practice, despite intensive treatment. Their characteristics were distinct by the reasons of D2T RA, which suggests the need for a personalized approach to D2T RA.
本研究旨在探讨治疗困难的类风湿关节炎（D2T RA）患者的临床特征，以及在真实世界中转换作用机制不同的药物的实用性。
我们回顾了 2016 年至 2017 年间在庆应义塾大学医院接受治疗的所有连续的 RA 患者，其中包括 D2T RA 的定义。我们分析了临床特征，并根据作用机制评估了药物转换的实用性。
在 1709 例 RA 患者中，有 173 例（10.1%）为 D2T RA。D2T RA 的原因是 59 例（34.1%）多药耐药、17 例（9.8%）合并症和 97 例（56.1%）社会经济原因。尽管接受了最强化的治疗，多药耐药组的压痛关节数和评估者整体评估明显更高。合并症组的年龄明显更大，风湿性疾病合并症指数更高。虽然将药物转换为另一种作用机制不同的药物是有用的，但随着转换次数的增加，达到缓解或低疾病活动度的患者比例下降。
在临床实践中，尽管进行了强化治疗，仍有 10.1%的 RA 患者治疗困难。根据 D2T RA 的原因，他们的特征明显不同，这表明需要对 D2T RA 采取个性化的方法。
