Nomura Manami, Sugihara Takahiko, Baba Hiroyuki, Hosoya Tadashi, Kamiya Mari, Ishizaki Tatsuro, Matsumoto Takumi, Kubo Kanae, Hirano Fumio, Kojima Masayo, Miyasaka Nobuyuki, Yasuda Shinsuke, Harigai Masayoshi
Department of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan.
Department of Medicine and Rheumatology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
Arthritis Res Ther. 2025 Feb 3;27(1):22. doi: 10.1186/s13075-025-03491-1.
Controlling disease activity and improving physical function would be more difficult in patients with late-onset rheumatoid arthritis (LORA) who have chronic lung disease (CLD) at baseline. Our aim was to evaluate 5-year outcomes of following a treat-to-target (T2T) strategy targeting low disease activity (LDA) in LORA with CLD.
Data from 197 methotrexate (MTX)-naïve LORA patients (mean age 74.4 years) from a prospective, monocentric registry were analyzed. Patients were treated with MTX if they had one or more poor prognostic features. If they had interstitial lung disease (ILD), tacrolimus could be administered instead of MTX at the discretion of the attending physician. If patients exhibited no response according to the European League Against Rheumatism criteria at week 12 or had not achieved LDA by week 24, biological disease-modifying antirheumatic drugs (bDMARDs) were started targeting LDA. The primary outcomes were the 5-year simplified disease activity index (SDAI) remission and Health Assessment Questionnaire Disability Index (HAQ-DI) ≤ 0.5 by non-responder imputation analysis. Secondary outcomes were serious adverse events (SAEs).
Of the 197 LORA patients, 47 had CLD at baseline. The proportion of patients using MTX at baseline was significantly lower in those with than without CLD. Tacrolimus was initiated in 25.5% of the CLD group. The proportion of patients on bDMARDs was higher in those with CLD at year 5. Achievement of SDAI remission at year 5 was 29.8% in patients with CLD and 44.0% in those without CLD (p = 0.555). Achievement of HAQ-DI ≤ 0.5 at year 5 was 36.2% and 45.3% in patients with and without CLD, respectively (p = 0.939). Non-adherence to T2T due to comorbidities or adverse events was observed in 34.0% and 18.7% of the patients with and without CLD, respectively (p = 0.027). Infections requiring hospitalization, deterioration of extra-articular manifestations and fractures were more frequently reported as SAEs in patients with CLD, and multivariable analysis showed that patients with CLD had a higher risk of developing these SAEs (adjusted hazard ratio:2.53, 95% CI 1.60-4.00, p < 0.001).
For LORA patients with CLD, the T2T strategy is effective, but comorbidities and SAEs make the implementation of the T2T more difficult.
对于基线时患有慢性肺病（CLD）的晚发型类风湿关节炎（LORA）患者，控制疾病活动和改善身体功能可能更具难度。我们的目的是评估针对LORA合并CLD患者采用以低疾病活动度（LDA）为目标的达标治疗（T2T）策略的5年结局。
对来自一项前瞻性单中心登记研究的197例未使用过甲氨蝶呤（MTX）的LORA患者（平均年龄74.4岁）的数据进行分析。如果患者有一项或多项不良预后特征，则给予MTX治疗。如果患者患有间质性肺病（ILD），主治医师可酌情给予他克莫司替代MTX。如果患者在第12周时未达到欧洲抗风湿病联盟标准的缓解，或在第24周时未达到LDA，则开始使用生物改善病情抗风湿药（bDMARDs）以达到LDA。主要结局为通过无反应者插补分析得出的5年简化疾病活动指数（SDAI）缓解和健康评估问卷残疾指数（HAQ-DI）≤0.5。次要结局为严重不良事件（SAEs）。
在197例LORA患者中，47例在基线时患有CLD。与无CLD的患者相比，有CLD的患者基线时使用MTX的比例显著更低。CLD组中25.5%的患者开始使用他克莫司。在第5年时，CLD患者中使用bDMARDs的比例更高。CLD患者在第5年时达到SDAI缓解的比例为29.8%，无CLD患者为44.0%（p = 0.555）。CLD患者和无CLD患者在第5年时达到HAQ-DI≤0.5的比例分别为36.2%和45.3%（p = 0.939）。分别有34.0%和18.7%的CLD患者和无CLD患者因合并症或不良事件未坚持T2T治疗（p = 0.027）。需要住院治疗的感染、关节外表现恶化和骨折在CLD患者中作为SAEs的报告更为频繁，多变量分析显示CLD患者发生这些SAEs的风险更高（调整后风险比：2.53，95%置信区间1.60 - 4.00，p < 0.001）。
对于合并CLD的LORA患者，T2T策略是有效的，但合并症和SAEs使T2T的实施更加困难。
