Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Arthritis Res Ther. 2024 Sep 17;26(1):161. doi: 10.1186/s13075-024-03390-x.
The current EULAR definition of difficult-to-treat rheumatoid arthritis (D2T-RA) identifies patients with active disease refractory to multiple treatments at a single time point, without considering the persistence of this condition over time. The study aimed to assess difficult-to-treat rheumatoid arthritis (D2T-RA) over 12 months, considering persistence over time rather than a single time point, in a real-life cohort.
In a single-center real-life cohort, demographic and clinic data were cross-sectionally collected for each patient at baseline and retrospectively over the previous 12 months bimonthly. For each timepoint, the prevalence of D2T-RA patients was calculated, and patients meeting the EULAR definition for at least 6 months were defined as persistent D2T-RA (pD2T-RA). Finally, the clinical characteristics associated with the time-based definition of pD2T-RA were analyzed.
Among 610 adult RA patients, 104 were refractory to ≥ 2 treatments. Initially, 41.3% met D2T-RA criteria, but only 27.9% fulfilled persistent D2T-RA (pD2T-RA) criteria over 6 months. The pD2T-RA group was associated with male gender, higher HAQ and Charlson Comorbidity Index scores, more failed treatments, and use of non-NSAID analgesics. Logistic regression linked pD2T-RA to higher SDAI and CRP values, and the use of glucocorticoids or analgesics. Chronic use of glucocorticoids was strongly associated with pD2T-RA.
The application of a temporal criterion allowed for the selection of a subgroup of pD2T-RA patients who differ from those who meet the definition of D2T-RA only episodically. Chronic use of glucocorticoids was the factor most strongly associated with pD2T-RA status.
目前 EULAR 对难治性类风湿关节炎（D2T-RA）的定义是指在单一时间点对多种治疗方法均无反应的活动期疾病患者，但并未考虑到随着时间的推移疾病的持续存在。本研究旨在评估在真实队列中，通过考虑随着时间的推移而不是单一时间点，D2T-RA 持续 12 个月的情况。
在单中心真实队列中，在基线时和之前的 12 个月内每两个月通过回顾性收集每位患者的人口统计学和临床数据。对于每个时间点，计算 D2T-RA 患者的患病率，并将符合 EULAR 定义至少 6 个月的患者定义为持续性 D2T-RA（pD2T-RA）。最后，分析与基于时间的 pD2T-RA 定义相关的临床特征。
在 610 例成人 RA 患者中，有 104 例患者对≥2 种治疗方法均无反应。最初，41.3%的患者符合 D2T-RA 标准，但仅 27.9%的患者在 6 个月内符合持续性 D2T-RA（pD2T-RA）标准。pD2T-RA 组与男性、更高的 HAQ 和 Charlson 合并症指数评分、更多治疗失败和使用非 NSAID 类镇痛药相关。Logistic 回归将 pD2T-RA 与更高的 SDAI 和 CRP 值以及使用糖皮质激素或镇痛药相关联。糖皮质激素的慢性使用与 pD2T-RA 密切相关。
应用时间标准可以选择一组持续性 D2T-RA 患者，他们与仅间歇性符合 D2T-RA 定义的患者不同。糖皮质激素的慢性使用是与 pD2T-RA 状态最密切相关的因素。
