Favalli Ennio Giulio, Biganzoli Giacomo, Cincinelli Gilberto, Ferrito Matteo, Luconi Ester, Manara Maria, Biggioggero Martina, Boracchi Patrizia, Caporali Roberto
Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO Institute, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Front Med (Lausanne). 2024 Dec 16;11:1509082. doi: 10.3389/fmed.2024.1509082. eCollection 2024.
The study aims to evaluate the applicability of the D2T psoriatic arthritis (PsA) definition, adapted from rheumatoid arthritis, within a single-center observational cohort of PsA patients treated with b/tsDMARDs. In addition, we aimed to establish a numerical index defining D2T-PsA based on the ratio of observed to expected failed b/tsDMARDs and to develop a predictive model identifying features associated with the D2T condition.
The study included 267 consecutive adult PsA patients receiving b/tsDMARDs, collecting demographic, clinical, and clinimetric data. The prevalence of D2T PsA patients was assessed using a proposed definition. We then developed a predictive model to assess treatment difficulty, utilizing PsA-normalized failed b/tsDMARDs. A generalized linear model was applied to identify clinical and demographic features associated with D2T PsA, employing a bagging procedure for robust variable selection, followed by univariate and multivariable analyses.
Among the 267 patients, only 8 of them (2.9%) met the proposed D2T PsA criteria. In a subset of 177 patients analyzed using the predictive model, 17.2% of them demonstrated higher treatment difficulty. Univariate analysis revealed associations between treatment difficulty and female sex, psoriasis pattern, fibromyalgia, and steroid therapy. Multivariate analysis confirmed significant associations between fibromyalgia, nail and pustular psoriasis, and steroid use.
According to the predictive model, the proposed D2T PsA definition identified a small subset of patients with increased treatment difficulty. These findings highlight the need for refining the criteria to better define D2T PsA patients, providing valuable insights into managing complex treatment challenges in PsA.
本研究旨在评估源自类风湿关节炎的D2T银屑病关节炎（PsA）定义在接受生物制剂或靶向合成改善病情抗风湿药（b/tsDMARDs）治疗的PsA患者单中心观察队列中的适用性。此外，我们旨在基于观察到的与预期的b/tsDMARDs治疗失败率建立一个定义D2T-PsA的数值指标，并开发一个预测模型来识别与D2T状态相关的特征。
本研究纳入了267例连续接受b/tsDMARDs治疗的成年PsA患者，收集了人口统计学、临床和临床测量数据。使用提议的定义评估D2T PsA患者的患病率。然后，我们开发了一个预测模型来评估治疗难度，利用PsA标准化的b/tsDMARDs治疗失败情况。应用广义线性模型来识别与D2T PsA相关的临床和人口统计学特征，采用装袋程序进行稳健的变量选择，随后进行单变量和多变量分析。
在267例患者中，只有8例（2.9%）符合提议的D2T PsA标准。在使用预测模型分析的177例患者子集中，17.2%的患者表现出更高的治疗难度。单变量分析显示治疗难度与女性性别、银屑病类型、纤维肌痛和类固醇治疗之间存在关联。多变量分析证实纤维肌痛、指甲和脓疱型银屑病以及类固醇使用之间存在显著关联。
根据预测模型，提议的D2T PsA定义识别出一小部分治疗难度增加的患者。这些发现凸显了完善标准以更好地定义D2T PsA患者的必要性，为应对PsA复杂的治疗挑战提供了有价值的见解。
