Department of Rheumatology and Immunology, University Hospital and University of Bern, Bern, Switzerland.
Statistics and Data Management Group, Swiss Clinical Quality Management Foundation, Zurich, Switzerland.
Arthritis Res Ther. 2024 Mar 14;26(1):68. doi: 10.1186/s13075-024-03302-z.
To investigate the clinical phenotype and treatment response in patients with rheumatoid arthritis (RA) with and without concomitant Sjögren's disease (SjD).
In this observational cohort study, patients with RA from the Swiss Clinical Quality Management in Rheumatic Diseases registry were categorised according to the presence or absence of SjD. To assess treatment effectiveness, drug retention of tumor necrosis factor-α-inhibitors (TNFi) was compared to other mode of action (OMA) biologics and Janus kinase-inhibitors (JAKi) in RA patients with and without SjD. Adjusted hazard ratios (HR) for time to drug discontinuation were compared in crude and adjusted Cox proportional regression models for potential confounders.
We identified 5974 patients without and 337 patients with concomitant SjD. Patients with SjD were more likely to be female, to have a positive rheumatoid factor, higher disease activity scores, and erosive bone damage. For treatment response, a total of 6781 treatment courses were analysed. After one year, patients with concomitant SjD were less likely to reach DAS28 remission with all three treatment modalities. Patients with concomitant SjD had a higher hazard for stopping TNFi treatment (adjusted HR 1.3 [95% CI 1.07-1.6]; OMA HR 1.12 [0.91-1.37]; JAKi HR 0.97 [0.62-1.53]). When compared to TNFi, patients with concomitant SjD had a significantly lower hazard for stopping treatment with OMA (adjusted HR 0.62 [95% CI 0.46-0.84]) and JAKi (HR 0.52 [0.28-0.96]).
RA patients with concomitant SjD reveal a severe RA phenotype, are less responsive to treatment, and more likely to fail TNFi.
探讨伴发干燥综合征（SjD）与不伴发干燥综合征的类风湿关节炎（RA）患者的临床表型和治疗反应。
在这项观察性队列研究中，根据是否存在 SjD，将瑞士风湿病临床质量控制管理注册研究中的 RA 患者进行分类。为了评估治疗效果，比较了伴发和不伴发 SjD 的 RA 患者中肿瘤坏死因子-α抑制剂（TNFi）与其他作用机制（OMA）生物制剂和 Janus 激酶抑制剂（JAKi）的药物保留率。在未经调整和调整后的 Cox 比例风险回归模型中，比较了潜在混杂因素的粗和调整后药物停药时间的风险比（HR）。
共纳入 5974 例不伴发 SjD 和 337 例伴发 SjD 的患者。伴发 SjD 的患者更可能为女性、类风湿因子阳性、疾病活动评分更高、存在侵蚀性骨损伤。在治疗反应方面，共分析了 6781 个治疗疗程。在第一年，伴发 SjD 的患者使用所有三种治疗方式达到 DAS28 缓解的可能性均较低。伴发 SjD 的患者停止 TNFi 治疗的风险更高（调整 HR 1.3 [95% CI 1.07-1.6]；OMA HR 1.12 [0.91-1.37]；JAKi HR 0.97 [0.62-1.53]）。与 TNFi 相比，伴发 SjD 的患者停止 OMA 治疗的风险显著降低（调整 HR 0.62 [95% CI 0.46-0.84]）和 JAKi（HR 0.52 [0.28-0.96]）。
伴发 SjD 的 RA 患者表现出更严重的 RA 表型，对治疗的反应较差，且更有可能对 TNFi 治疗失败。
