Philippoteaux Cécile, Marty-Ane Anne, Cailliau Emeline, Labreuche Julien, Philippe Peggy, Cortet Bernard, Paccou Julien, Flipo Rene-Marc, Letarouilly Jean-Guillaume
Rheumatology Department, Lille University Hospital, Lille, France.
Rheumatology Department, Lille University Hospital, Lille, France.
Semin Arthritis Rheum. 2023 Dec;63:152275. doi: 10.1016/j.semarthrit.2023.152275. Epub 2023 Oct 5.
The EULAR task force recently published the difficult-to-treat rheumatoid arthritis (D2T RA) criteria, however, a definition of D2T patients in psoriatic arthritis (PsA) is still lacking. To date, we have little data concerning D2T PsA, especially in real-world. One of the limitations of the D2T RA EULAR definition is the absence of a temporal criterion. The primary endpoint of this work was to study the characteristics of D2T PsA patients using the EULAR definition. The second objective was to study a sub-group of patients with a predefined more stringent definition including a temporal criterion.
A retrospective study was performed in a tertiary center. D2T PsA was defined as failure of ≥ 2 b/tsDMARDs with different mechanism of action. Very D2T PsA was defined as failure of ≥ 2 b/tsDMARDs in less than 2 years of follow-up. D2T and Very D2T PsA patients were compared to nD2T PsA patients using statistical tests.
150 PsA patients were included (from 2004 to 2015): 49 D2T PsA and 101 nD2T PsA. D2T PsA was associated with a higher prevalence of axial involvement (p=0.030), axial and/or peripheral structural damage (p=0.007) at baseline and more bDMARDs discontinuation due to poor dermatological control (p=0.005). There was no significant difference regarding comorbidities such as obesity, smoking status, fibromyalgia or depression. In multivariate analysis, peripheral structural damage at baseline was found to be a predictive factor for D2T PsA with an OR of 2.57 (1.16 to 5.69; p=0.020). 17 PsA (11.3%) patients were categorized as Very D2T PsA. When compared to nD2T group, proportion of obesity was higher (p=0.015) and axial involvement was more prevalent in the Very D2T group (p=0.020).
D2T PsA patients had a higher prevalence of axial involvement, peripheral structural damage and therapeutic discontinuation due to poor dermatological control whereas Very D2T PsA patients were more likely obese with axial involvement. Very D2T PsA represent a minim proportion among patients when applying a more stringent definition. Pending the PsA D2T definition by the European and American societies, this study highlights some characteristics that may help practitioners better identify D2T patients.
欧洲抗风湿病联盟（EULAR）特别工作组最近发布了难治性类风湿关节炎（D2T RA）标准，然而，银屑病关节炎（PsA）中D2T患者的定义仍缺失。迄今为止，我们关于D2T PsA的数据很少，尤其是在真实世界中。D2T RA的EULAR定义的局限性之一是缺乏时间标准。这项研究的主要终点是使用EULAR定义研究D2T PsA患者的特征。第二个目标是研究一组具有预先定义的更严格定义（包括时间标准）的患者亚组。
在一家三级中心进行了一项回顾性研究。D2T PsA被定义为≥2种具有不同作用机制的生物/靶向合成改善病情抗风湿药（b/tsDMARDs）治疗失败。极难治性PsA（Very D2T PsA）被定义为在不到2年的随访中≥2种b/tsDMARDs治疗失败。使用统计检验将D2T和Very D2T PsA患者与非难治性PsA（nD2T PsA）患者进行比较。
纳入了150例PsA患者（2004年至2015年）：49例D2T PsA和101例nD2T PsA。D2T PsA与基线时更高的轴向受累患病率（p = 0.030）、轴向和/或外周结构损伤患病率（p = 0.007）以及更多因皮肤控制不佳导致的生物制剂停药相关（p = 0.005）。在肥胖、吸烟状况、纤维肌痛或抑郁症等合并症方面没有显著差异。在多变量分析中，发现基线时的外周结构损伤是D2T PsA的预测因素，比值比为2.57（1.16至5.69；p = 0.020）。17例PsA（11.3%）患者被归类为Very D2T PsA。与nD2T组相比，肥胖比例更高（p = 0.015），Very D2T组中轴向受累更普遍（p = 0.020）。
D2T PsA患者轴向受累、外周结构损伤以及因皮肤控制不佳导致治疗停药的患病率更高，而Very D2T PsA患者更可能肥胖且有轴向受累。在应用更严格定义时，Very D2T PsA在患者中占比极小。在欧美社会给出PsA的D2T定义之前，本研究突出了一些可能有助于医生更好识别D2T患者的特征。
