Alp Gülay, Kara Mete, Cinakli Haluk
Rheumatology Clinic, Bingöl State Hospital, Bingöl, Turkey.
Rheumatology Clinic, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey.
Clin Exp Rheumatol. 2025 Jan;43(1):41-47. doi: 10.55563/clinexprheumatol/pqpzef. Epub 2024 Aug 8.
The challenge of achieving low disease activity or remission in psoriatic arthritis (PsA) is an unmet need for many patients. Persistent disease activity in PsA may require treatment adjustments due to its complex pathogenesis and varied tissue involvement, highlighting the need for dedicated definitions. This study evaluates patients' frequency and contributing factors with potential "difficult-to-treat PsA (D2TPsA)", similar to the EULAR definition of D2T rheumatoid arthritis.
A retrospective study was conducted at two tertiary centres to define potential D2TPsA, defined as failure of ≥1 conventional synthetic disease-modifying anti-rheumatic drug (DMARD) and ≥2 biological or targeted synthetic DMARDs with different mechanisms of action.
Of the 171 patients included in the study, 116 (67.8%) were women; the average age was 48.16 ±11.23 years. D2TPsA was detected in 33 patients (19.3%). This group exhibited a longer disease duration, higher disease burden (median number of tender and swollen joints, patient and physician global evaluation, morning stiffness, erythrocyte sedimentation rate and C-reactive protein, DAPSA), HLA-B27 positivity, and higher prevalence of peripheral involvement. Secukinumab usage and mean glucocorticosteroid dosage were significantly higher in the D2TPsA group. Comorbidities such as fibromyalgia (FM) and diabetes mellitus (DM) and the median number of comorbidities were significantly higher in D2TPsA. In multivariate analysis, FM, DM, and HLA-B27 positivity were independently associated with D2TPsA.
This study underscores the impact of comorbidities on PsA disease activity and emphasises the need for further research to differentiate treatment challenges influenced by comorbidities from true treatment resistance.
对于许多银屑病关节炎（PsA）患者而言，实现疾病低活动度或缓解仍然是一项未被满足的需求。由于PsA发病机制复杂且组织受累情况多样，疾病活动持续存在可能需要调整治疗方案，这凸显了专门定义的必要性。本研究评估了与欧洲抗风湿病联盟（EULAR）对难治性类风湿关节炎的定义类似的潜在“难治性PsA（D2TPsA）”患者的频率及相关因素。
在两个三级中心进行了一项回顾性研究，以定义潜在的D2TPsA，其定义为≥1种传统合成改善病情抗风湿药（DMARD）及≥2种作用机制不同的生物或靶向合成DMARD治疗失败。
纳入研究的171例患者中，116例（67.8%）为女性；平均年龄为48.16±11.23岁。33例（19.3%）患者检测到DTPsA。该组患者病程更长、疾病负担更高（压痛和肿胀关节的中位数、患者和医生整体评估、晨僵、红细胞沉降率和C反应蛋白、DAPSA）、HLA - B27阳性率更高，外周受累患病率更高。D2TPsA组司库奇尤单抗的使用和糖皮质激素平均剂量显著更高。D2TPsA组纤维肌痛（FM）和糖尿病（DM）等合并症以及合并症的中位数显著更高。多因素分析中，FM、DM和HLA - B27阳性与D2TPsA独立相关。
本研究强调了合并症对PsA疾病活动的影响，并强调需要进一步研究以区分合并症影响的治疗挑战与真正的治疗抵抗。
