Takanashi Satoshi, Takeuchi Tsutomu, Kaneko Yuko
Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Saitama Medical University, Saitama, Japan.
Rheumatology (Oxford). 2025 May 1;64(5):2487-2495. doi: 10.1093/rheumatology/keae325.
To elucidate the long-term outcomes of patients with difficult-to-treat rheumatoid arthritis (D2T RA).
We collected data on the clinical course of patients who had been identified as D2T RA in 2018 until 2023. We stratified the patients according to outcomes at the last visit: resolved D2T RA, persistent D2T RA and mortality. We compared their clinical characteristics and investigated the predictive factors for the resolution of D2T RA or mortality. Furthermore, we investigated the impact of the causes of D2T RA identified in 2018, multidrug resistance, comorbidities and socioeconomic factors on outcomes in 2023.
Of 173 patients identified as D2T RA in 2018, 150 were included in the analysis. Among them, D2T RA was resolved in 67 (45%), 75 (50%) remained as D2T RA, and 8 (5%) died. Patients with resolved D2T RA were significantly younger at the latest visit (P = 0.02), had a higher proportion of treatment changes during five years (P = 0.002), and had a higher proportion of interleukin-6 receptor inhibitors use in 2023 (P = 0.04) than those in patients with persistent D2T RA or those who died. D2T RA resolved in 38% of patients with multidrug resistance, mainly with treatment changes. Rheumatic disease comorbidity index and glucocorticoid dose escalation were independent risk factors for mortality [odds ratio (OR), 3.50; P = 0.02 and OR, 31.9; P = 0.002, respectively].
Further modifications in RA treatment are useful for resolving D2T RA. Multiple comorbidities and glucocorticoid use are associated with mortality.
阐明难治性类风湿关节炎（D2T RA）患者的长期预后。
我们收集了2018年至2023年期间被确定为难治性类风湿关节炎患者的临床病程数据。我们根据末次随访结果对患者进行分层：难治性类风湿关节炎缓解、难治性类风湿关节炎持续存在和死亡。我们比较了他们的临床特征，并研究了难治性类风湿关节炎缓解或死亡的预测因素。此外，我们研究了2018年确定的难治性类风湿关节炎病因、多药耐药、合并症和社会经济因素对2023年预后的影响。
2018年确定为难治性类风湿关节炎的173例患者中，150例纳入分析。其中，67例（45%）难治性类风湿关节炎得到缓解，75例（50%）仍为难治性类风湿关节炎，8例（5%）死亡。与难治性类风湿关节炎持续存在或死亡的患者相比，难治性类风湿关节炎缓解的患者在末次随访时明显更年轻（P = 0.02），五年内治疗改变的比例更高（P = 0.002），2023年白细胞介素-6受体抑制剂的使用比例更高（P = 0.04）。38%的多药耐药患者难治性类风湿关节炎得到缓解，主要是通过治疗改变。风湿性疾病合并症指数和糖皮质激素剂量增加是死亡的独立危险因素[比值比（OR）分别为3.50；P = 0.02和OR为31.9；P = 0.002]。
类风湿关节炎治疗的进一步调整有助于缓解难治性类风湿关节炎。多种合并症和糖皮质激素的使用与死亡率相关。
