Department of Rheumatology and Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.
Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China.
Clin Rheumatol. 2021 Oct;40(10):4029-4038. doi: 10.1007/s10067-021-05687-7. Epub 2021 May 3.
To explore the characteristics of refractory RA and its contributory factors based on the understanding of the rheumatologists of China.
A national cross-sectional survey was performed in 32 provinces across China, and 1381 rheumatologists were recruited. Information about the sociodemographic background, refractory RA characteristics, and contributory factors was collected using a pre-made questionnaire including fourteen single-choice and four multiple-choice questions, respectively. Each of the single-choice and multiple-choice question had several items.
In response to the single-choice questions regarding the definition of refractory RA, 52.28% responded that "the 28 joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR) > 5.1 with presence of signs suggestive of inflammatory disease" is characteristic of refractory RA, whereas 50.18% opined that "If target was not achieved with 2 conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) combined with 1 biological or 1 targeted synthetic DMARD (b/tsDMARD), over a total of 3~6 months" should be considered refractory RA. In addition, 39.32% rheumatologists were in favor of inability to taper glucocorticoids (GCs) ≤ 10mg prednisone or equivalent daily. Additional features considered characteristics of refractory RA were extra-articular manifestations (84.94%), interfering comorbidities (76.32%), and radiographic progression (71.83%). Among the contributory factors, 92.03% considered infection, and interstitial lung disease was chosen by 90.95%, vasculitis by 82.26%, osteoporosis by 70.67%, and fibromyalgia syndrome by 70.38%.
Our survey has demonstrated a variety of concepts of refractory RA among the rheumatologists of China. Disease activity assessment, treatment options, interfering comorbidities, and radiological progression all were associated with the characteristics of refractory RA. Key Points • This study demonstrated the definition, characteristics, and contributing factors of refractory RA from the rheumatologists' views in China. • The clarification of the insights and concepts on refractory RA will help to make comprehensive guidelines to treat this disease, further improving prognosis and reducing the societal burdens of RA.
基于中国风湿病医师的认识，探讨难治性 RA 的特征及其相关因素。
在中国 32 个省进行了一项全国性横断面调查，共招募了 1381 名风湿病医师。使用预先制定的问卷收集了有关社会人口统计学背景、难治性 RA 特征和相关因素的信息，问卷包括 14 个单项选择题和 4 个多项选择题，每个单项选择题和多项选择题都有几个项目。
对于难治性 RA 的定义的单项选择题，52.28%的人回答“28 关节疾病活动评分-红细胞沉降率（DAS28-ESR）>5.1 且存在提示炎症性疾病的体征”是难治性 RA 的特征，而 50.18%的人认为“如果在总共 3 至 6 个月内，2 种常规合成的疾病修饰抗风湿药物（csDMARDs）联合 1 种生物或 1 种靶向合成 DMARD（b/tsDMARD）治疗目标未达到”应被视为难治性 RA。此外，39.32%的风湿病医师赞成无法将糖皮质激素（GCs）≤10mg 泼尼松或等效剂量每日逐渐减少。另外，关节外表现（84.94%）、合并症（76.32%）和影像学进展（71.83%）也被认为是难治性 RA 的特征。在相关因素中，92.03%的人认为感染是一个因素，90.95%的人选择间质性肺疾病，82.26%的人选择血管炎，70.67%的人选择骨质疏松症，70.38%的人选择纤维肌痛综合征。
我们的调查表明，中国风湿病医师对难治性 RA 的概念存在多种理解。疾病活动评估、治疗选择、合并症和影像学进展都与难治性 RA 的特征有关。
• 本研究从中国风湿病医师的角度展示了难治性 RA 的定义、特征和相关因素。
• 阐明对难治性 RA 的见解和概念将有助于制定全面的治疗指南，进一步改善预后并降低 RA 的社会负担。
