Potapova A S, Karateev A E, Polishchuk E Y, Filatova E S, Amirdzhanova V N, Lila A M
Nasonova Research Institute of Rheumatology.
Russian Medical Academy of Continuous Professional Education.
Ter Arkh. 2024 Jun 3;96(5):465-470. doi: 10.26442/00403660.2024.05.202701.
Clinical guidelines for the treatment of rheumatoid arthritis (RA) recommend reducing the use of glucocorticoids (GCs) due to the high risk of associated complications.
To determine the frequency of GC cancellations and dose reductions in real clinical practice, while taking into account active RA therapy.
The study group consisted of 303 patients with RA reliable according to ACR/EULAR criteria (women 79.9%, age 52.8±13.3, disease duration 9 [4; 16] years, DAS-28-CRP 4.9±1.0, RF seropositivity 77.4%, ACPA seropositivity 70.3%), who were prescribed or changed therapy with disease-modifying antirheumatic drugs (DMARDs), biologic disease-modifying antirheumatic drugs (bDMARDs) or Janus kinase inhibitors (iJAK) due to disease exacerbation and ineffectiveness of previous treatment. All patients initially received GC (7.7±3.8 mg/day equivalent of prednisolone). After adjustment of therapy, 42.9% of patients received methotrexate, 27.6% leflunomide, 2.5% sulfasalazine, hydroxychloroquine, or a combination with an Non-steroidal anti-inflammatory drugs, 63.7% bDMARDs, and 7.2% iJAK. The need for GC intake was assessed by a telephone survey conducted 6 months after the start of follow-up.
Telephone survey was possible in 274 (90.4%) persons. There was a significant decrease in pain intensity (numerical rating scale, NRS 0-10) from 6.3±1.4 to 4.3±2.4 (<0.001), fatigue (NRS) from 6.7±2.3 to 5.2±2.1 (<0.001), and functional impairment (NRS) from 5.4±2.1 to 3.9±2.0 (<0.001). A positive PASS index (symptom status acceptable to patients) was noted in 139 (50.7%) patients. GC cancellation was noted in 19.7%, dose reduction in 25.9%, maintaining the same dose in 42.7%, and dose increase in 11.7%.
Against the background of intensive RA therapy, including combination of DMARDs with bDMARDs or iJAK, complete withdrawal or reduction of GC dose was achieved in less than half (45.6%) of patients after 6 months.
类风湿关节炎（RA）治疗的临床指南建议减少糖皮质激素（GCs）的使用，因为其相关并发症风险高。
在考虑RA积极治疗的情况下，确定实际临床实践中GC停用和剂量减少的频率。
研究组由303例符合美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）标准的RA患者组成（女性占79.9%，年龄52.8±13.3岁，病程9[4；16]年，DAS-28-CRP为4.9±1.0，类风湿因子血清阳性率为77.4%，抗环瓜氨酸肽抗体血清阳性率为70.3%），这些患者因疾病加重和先前治疗无效而接受或更改改善病情抗风湿药（DMARDs）、生物改善病情抗风湿药（bDMARDs）或Janus激酶抑制剂（iJAK）治疗。所有患者最初均接受GC治疗（相当于泼尼松龙7.7±3.8mg/天）。调整治疗后，42.9%的患者接受甲氨蝶呤治疗，27.6%接受来氟米特治疗，2.5%接受柳氮磺吡啶、羟氯喹或与非甾体抗炎药联合治疗，63.7%接受bDMARDs治疗，7.2%接受iJAK治疗。在随访开始6个月后通过电话调查评估GC摄入的必要性。
274人（90.4%）可以进行电话调查。疼痛强度（数字评分量表，NRS 0-10）从6.3±1.4显著降至4.3±2.4（<0.001），疲劳（NRS）从6.7±2.3降至5.2±2.1（<0.001），功能障碍（NRS）从5.4±2.1降至3.9±2.0（<0.001）。139例（50.7%）患者的患者可接受症状状态（PASS）指数为阳性。19.7%的患者停用GC，25.9%的患者减少剂量，42.7%的患者维持相同剂量，11.7%的患者增加剂量。
在包括DMARDs与bDMARDs或iJAK联合使用的强化RA治疗背景下，6个月后不到一半（45.6%）的患者实现了GC的完全停用或剂量减少。
