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合并症、糖尿病和吸烟对类风湿关节炎持续结局的影响:一项回顾性研究。

Impact of comorbidities, diabetes, and smoking on sustained outcomes in rheumatoid arthritis: a retrospective study.

作者信息

Apostolova Zhaklin, Shivacheva Tanya, Georgiev Tsvetoslav

机构信息

First Department of Internal Medicine, Faculty of Medicine, University Hospital St. Marina, Medical University - Varna, Bulgaria.

出版信息

Reumatologia. 2025 Apr 14;63(2):97-103. doi: 10.5114/reum/199933. eCollection 2025.

Abstract

INTRODUCTION

Rheumatoid arthritis (RA) is a chronic autoimmune disease significantly impacting patients' quality of life (QoL) and necessitating complex, long-term treatment. This study aimed to assess the long-term therapeutic outcomes of biologic therapies in a real-world clinical setting, focusing on the achievement and maintenance of low disease activity (LDA) among RA patients, while also investigating factors influencing these outcomes.

MATERIAL AND METHODS

A retrospective observational analysis was conducted on 190 RA patients receiving tumor necrosis factor α (TNF-α) or interleukin (IL)-6 inhibitors. Disease activity was evaluated using the Disease Activity Score 28 (DAS28) at baseline, 6 months, and 12 months. Based on the DAS28 with C-reactive protein (DAS28-CRP) values, the disease was categorized into 2 main groups: remission/low activity (target achieved) when the DAS28-CRP value was less than 3.2, and insufficient therapeutic response when the value exceeded 3.2.

RESULTS

The study group consisted of 190 RA patients, predominantly women (85.8%), with a mean age of 58.7 years and a disease duration of 12.5 years. We found that 45.8% of patients achieved single-point LDA, with 39.5% sustaining this response after 12 months. Notably, comorbidities such as diabetes and smoking negatively affected the likelihood of maintaining LDA. Statistical analysis revealed that patients without diabetes had a significantly higher chance of retaining sustained LDA (OR = 0.100; = 0.014).

CONCLUSIONS

These findings emphasize the need for personalized treatment approaches that consider comorbidities and lifestyle factors to enhance long-term therapeutic efficacy in RA management. Consequently, this study highlights the critical importance of ongoing monitoring and individualized strategies to improve outcomes and QoL for patients with RA.

摘要

引言

类风湿性关节炎(RA)是一种慢性自身免疫性疾病,严重影响患者的生活质量(QoL),需要进行复杂的长期治疗。本研究旨在评估生物疗法在真实临床环境中的长期治疗效果,重点关注类风湿性关节炎患者低疾病活动度(LDA)的实现和维持,同时研究影响这些结果的因素。

材料与方法

对190名接受肿瘤坏死因子α(TNF-α)或白细胞介素(IL)-6抑制剂治疗的类风湿性关节炎患者进行回顾性观察分析。在基线、6个月和12个月时使用疾病活动评分28(DAS28)评估疾病活动度。根据DAS28与C反应蛋白(DAS28-CRP)值,将疾病分为2个主要组:当DAS28-CRP值小于3.2时为缓解/低活动度(达到目标),当值超过3.2时为治疗反应不足。

结果

研究组由190名类风湿性关节炎患者组成,主要为女性(85.8%),平均年龄58.7岁,病程12.5年。我们发现45.8%的患者实现了单点LDA,其中39.5%在12个月后维持了这种反应。值得注意的是,糖尿病和吸烟等合并症对维持LDA的可能性有负面影响。统计分析显示,没有糖尿病的患者维持持续LDA的机会显著更高(OR = 0.100;P = 0.014)。

结论

这些发现强调了需要采用个性化治疗方法,考虑合并症和生活方式因素,以提高类风湿性关节炎管理中的长期治疗效果。因此,本研究强调了持续监测和个性化策略对于改善类风湿性关节炎患者的治疗结果和生活质量的至关重要性。

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Impact of comorbidities, diabetes, and smoking on sustained outcomes in rheumatoid arthritis: a retrospective study.
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