少关节型幼年特发性关节炎中决定对传统改善病情抗风湿药物治疗耐药性的因素
Factors determining resistance to conventional disease-modifying anti-rheumatic drug treatment in oligoarticular juvenile idiopathic arthritis.
作者信息
Sener Seher, Aliyev Emil, Batu Ezgi Deniz, Balik Zeynep, Bayindir Yagmur, Cam Veysel, Basaran Ozge, Bilginer Yelda, Ozen Seza
机构信息
Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Sihhiye Campus, 06100, Ankara, Turkey.
出版信息
Clin Rheumatol. 2024 Jun;43(6):2021-2026. doi: 10.1007/s10067-024-06925-4. Epub 2024 Apr 29.
OBJECTIVE
Our study was designed to investigate the reasons for starting the conventional disease-modifying anti-rheumatic drugs (DMARDs) and the variables that impact the response to DMARD treatment in oligoarticular juvenile idiopathic arthritis (JIA) patients.
METHODS
Oligoarticular JIA patients (n = 187) were categorized into two groups: Group A consisted of patients who achieved remission with DMARD, and Group B comprised those who did not respond to DMARD therapy.
RESULTS
DMARDs were initiated for various reasons: 68 (36.4%) due to active disease despite nonsteroidal anti-inflammatory drugs (± intra-articular corticosteroid) treatment, 59 (31.6%) due to uveitis, 49 (26.2%) due to extended oligoarticular JIA, and 11 (5.9%) due to inflammatory bowel disease. One hundred twenty-three patients (65.8%) achieved remission with DMARDs (Group A), while 64 patients (34.2%) did not respond to DMARD therapy (Group B). In Group B, patients had higher C-reactive protein (CRP) levels as well as higher Juvenile Idiopathic Arthritis Disease Activity Scores-71 (JADAS-71) at diagnosis (both p < 0.001). Moreover, extended oligoarticular JIA subtype (p = 0.017) and involvement of small joints at diagnosis (p = 0.043) were more prevalent among these patients. Group A exhibited a higher frequency of antinuclear antibody positivity (p = 0.014). Elevated CRP levels (> 1.1 mg/dL) (OR 1.308, 95% CI 1.203-3.574; p < 0.001) and high JADAS-71 at diagnosis (> 15.8) (OR 1.659, 95% CI 1.179-2.941; p < 0.001) were associated with DMARD resistance.
CONCLUSION
Elevated CRP and high JADAS-71 at diagnosis were the main factors associated with DMARD resistance in oligoarticular JIA. Prospective long-term studies may help verify the role of these factors associated with DMARD resistance in oligoarticular JIA. Key Points • Conventional DMARDs were most commonly started due to active disease despite NSAID (± intra-articular corticosteroids). • Remission was achieved with DMARD in 65.8% of oligoarticular JIA patients. • Elevated CRP and high JADAS-71 at diagnosis were associated with DMARD resistance.
目的
我们的研究旨在调查开始使用传统改善病情抗风湿药物（DMARDs）的原因以及影响少关节型幼年特发性关节炎（JIA）患者对DMARD治疗反应的变量。
方法
少关节型JIA患者（n = 187）被分为两组：A组由使用DMARD达到缓解的患者组成，B组由对DMARD治疗无反应的患者组成。
结果
开始使用DMARDs有多种原因：68例（36.4%）是因为尽管使用了非甾体抗炎药（±关节内注射皮质类固醇）治疗但疾病仍处于活动期，59例（31.6%）是因为葡萄膜炎，49例（26.2%）是因为少关节型JIA病情扩展，11例（5.9%）是因为炎症性肠病。123例患者（65.8%）使用DMARDs后达到缓解（A组），而64例患者（34.2%）对DMARD治疗无反应（B组）。在B组中，患者在诊断时C反应蛋白（CRP）水平较高，幼年特发性关节炎疾病活动评分-71（JADAS-71）也较高（两者p均<0.001）。此外，少关节型JIA病情扩展亚型（p = 0.017）和诊断时小关节受累（p = 0.043）在这些患者中更为普遍。A组抗核抗体阳性频率较高（p = 0.014）。诊断时CRP水平升高（>1.1mg/dL）（比值比1.308，95%置信区间1.203 - 3.574；p<0.001）和诊断时JADAS-71较高（>15.8）（比值比1.659，95%置信区间1.179 - 2.941；p<0.001）与DMARD抵抗相关。
结论
诊断时CRP升高和JADAS-71较高是少关节型JIA中与DMARD抵抗相关的主要因素。前瞻性长期研究可能有助于验证这些与少关节型JIA中DMARD抵抗相关因素的作用。要点 • 尽管使用了非甾体抗炎药（±关节内注射皮质类固醇）但疾病仍处于活动期是最常见开始使用传统DMARDs的原因。 • 65.8%的少关节型JIA患者使用DMARDs后达到缓解。 • 诊断时CRP升高和JADAS-71较高与DMARD抵抗相关。
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