Saygın Öğüt Tahir, Erbasan Funda, Şahiner Mehmet Fatih, Nokay Mine, Yörük Öğüt Ayşe, Dilbil Melis, Terzioğlu Mustafa Ender, Yazısız Veli
Department of Internal Medicine, Division of Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Türkiye.
Department of Internal Medicine, Akdeniz University Faculty of Medicine, Antalya, Türkiye.
Arch Rheumatol. 2024 Aug 26;39(3):419-428. doi: 10.46497/ArchRheumatol.2024.10567. eCollection 2024 Sep.
This study aimed to formulate D2T (difficult to treat) criteria for axial spondyloarthritis (AxSpA) patients and identify the prevalence of D2T patients and their characteristics.
The cross-sectional study was conducted with 166 AxSpA patients (93 males, 73 females; mean age: 47.1±12.9 years; range, 19 to 78 years) between February 2023 and March 2023. The criteria were based on patients treated according to the European Alliance of Associations for Rheumatology (EULAR) recommendations for AxSpA. Entry criteria were treatment failure to ≥2 biological/targeted synthetic disease-modifying antirheumatic drugs with two different mechanisms of action or ≥3 biological/targeted synthetic disease-modifying antirheumatic drugs. Potential preliminary factors for D2T criteria were analyzed, and the characteristics of the subjects matching D2T criteria were compared with those of others.
One hundred forty-two ankylosing spondylitis patients and 24 nonradiographic AxSpA patients were included in the study. The rate of fulfilling the D2T criteria was 22.9% (n=38) among AxsPA patients treated with biological agents. The potential D2T criteria were met by 23.2% of ankylosing spondylitis and 20.8% of nonradiographic AxSpA patients. Baseline characteristics, such as sex, age, diagnosis age, occupation, and education, of D2T patients were not statistically different from other patients. The prevalence of fibromyalgia was higher in D2T patients (p<0.001). Disease activity indices and acute phase response indicators were higher and quality of life was worse in D2T patients.
There was a considerable amount of AxSpA patients fulfilling the D2T criteria despite new and effective treatment agents.
本研究旨在制定轴性脊柱关节炎（AxSpA）患者的难治性（D2T）标准，并确定难治性患者的患病率及其特征。
于2023年2月至2023年3月对166例AxSpA患者（93例男性，73例女性；平均年龄：47.1±12.9岁；范围19至78岁）进行了横断面研究。该标准基于根据欧洲风湿病协会联盟（EULAR）AxSpA推荐方案接受治疗的患者。纳入标准为对≥2种具有两种不同作用机制的生物制剂/靶向合成改善病情抗风湿药或≥3种生物制剂/靶向合成改善病情抗风湿药治疗失败。分析了难治性标准的潜在初步因素，并将符合难治性标准的受试者特征与其他受试者进行了比较。
本研究纳入了142例强直性脊柱炎患者和24例非放射学AxSpA患者。接受生物制剂治疗的AxSpA患者中符合难治性标准的比例为22.9%（n = 38）。23.2%的强直性脊柱炎患者和20.8%的非放射学AxSpA患者符合潜在难治性标准。难治性患者的基线特征，如性别、年龄、诊断年龄、职业和教育程度，与其他患者无统计学差异。难治性患者中纤维肌痛的患病率更高（p<0.001）。难治性患者的疾病活动指数和急性期反应指标更高，生活质量更差。
尽管有新的有效治疗药物，但仍有相当数量的AxSpA患者符合难治性标准。
