Division of Rheumatology, CHU de Quebec-Université Laval, Quebec City, Canada.
Department of Medicine, Université Laval, Quebec City, Canada.
Adv Rheumatol. 2024 Aug 6;64(1):55. doi: 10.1186/s42358-024-00396-6.
In 2021, an EULAR task force published a definition of difficult-to-treat rheumatoid arthritis (D2T RA). Our current knowledge of D2T RA with the EULAR definition is based on European and Asian cohorts, and no North American cohort has yet to be published. The aim of this study was to compare D2T RA patients to non-D2T RA who are good responders to advanced therapy, and to describe their evolution in an university health center patient cohort.
This is a retrospective single centre study of the medical records of all adults with RA on at least one biologic or target synthetic DMARD (b/tsDMARD). D2T RA group was defined according to the EULAR definition of D2T RA. The non-D2T RA group was defined as a b/tsDMARD good responder who had low-disease activity or remission for at least one year on 1 or 2 b/tsDMARD mechanism of action. We compared the patients' comorbidities, and history of b/tsDMARD use. Descriptive statistics and proportions were calculated. Kaplan-Meier analysis with log-rank test was used to estimate and compare median survival.
Among the 417 patients, 101 (24%) were D2T RA and 316 (76%) were non-D2T RA. D2T RA group was slightly younger (63 ± 9 years versus 65 ± 12 years, p = 0.045), more likely to have concomitant non-inflammatory pain (28% versus 8%, p < 0.0001) and to discontinue at least one b/tsDMARD due to intolerance (39% versus 10%, p < 0.0001). In the D2T RA group, JAK inhibitors were associated with longer drug continuation when used as the third b/tsDMARD. Fewer patients were using corticosteroid at their most recent follow-up in this Canadian cohort compared to others (16% versus from 29 to 74%).
Concomitant non-inflammatory pain was more prevalent in D2T RA patients compared to b/tsDMARD good responder non-D2T RA patients. Steroid-sparing strategies is possible even in D2T RA patients. Future prospective research may compare JAK inhibitors with other mechanisms of action in D2T RA.
2021 年，EULAR 工作组发布了难治性类风湿关节炎（D2T RA）的定义。目前，我们对 EULAR 定义的 D2T RA 的认识主要基于欧洲和亚洲队列，尚未有北美队列发表。本研究旨在比较 D2T RA 患者与对高级治疗有良好反应的非 D2T RA 患者，并描述他们在大学健康中心患者队列中的演变。
这是一项回顾性单中心研究，纳入了至少使用一种生物制剂或靶向合成疾病修饰抗风湿药物（b/tsDMARD）的所有成人 RA 患者的病历。D2T RA 组根据 EULAR 对 D2T RA 的定义进行定义。非 D2T RA 组定义为使用 1 种或 2 种 b/tsDMARD 作用机制，至少 1 年低疾病活动度或缓解的 b/tsDMARD 良好反应者。我们比较了患者的合并症和 b/tsDMARD 的使用史。计算描述性统计数据和比例。使用 Kaplan-Meier 分析和对数秩检验来估计和比较中位生存期。
在 417 名患者中，101 名（24%）为 D2T RA，316 名（76%）为非 D2T RA。D2T RA 组略年轻（63±9 岁与 65±12 岁，p=0.045），更有可能同时存在非炎症性疼痛（28%与 8%，p<0.0001），并且因不耐受而至少停用一种 b/tsDMARD（39%与 10%，p<0.0001）。在 D2T RA 组中，JAK 抑制剂作为第三种 b/tsDMARD 时与药物续用时间更长相关。与其他队列相比，在本加拿大队列中，最近一次随访时使用皮质类固醇的患者较少（16%与 29%至 74%）。
与 b/tsDMARD 良好反应的非 D2T RA 患者相比，D2T RA 患者同时存在非炎症性疼痛更为常见。即使在 D2T RA 患者中，也可以采用类固醇节约策略。未来的前瞻性研究可能会比较 D2T RA 中 JAK 抑制剂与其他作用机制。
