在综合评估计划中难以治疗类风湿性关节炎:根据不同客观评估的频率
Rodrigo Garcia-Salinas1, Einer Sanchez-Prado2, Jonatan Mareco2,3
1Rheumatology Unit, Hospital Italiano de La Plata, 51 Street, 1725, 1900, La Plata, Buenos Aires Province, Argentina. gsalinasrodrigo@gmail.com.
Rheumatology international
|June 3, 2023
概括
这项研究发现,27.5%的类风湿性关节炎患者难以治疗,贫血和高射频标位是关键因素. 一年后,33%的患者仍然难以治疗,ACPA阳性和侵蚀预测了这种结果.
科学领域:
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
- 临床医学 临床医学
背景情况:
- 难以治疗的类风湿性关节炎 (RA-D2T) 是一个重大挑战,尽管有先进疗法,但患者未能达到治疗目标.
- 包括临床,血清学和成像数据在内的全面评估对于理解RA-D2T至关重要.
- 评估RA-D2T的频率和预测因素对于优化患者管理至关重要.
研究的目的:
- 为了估计RA-D2T在综合评估的队列中的频率.
- 确定与RA-D2T相关的临床,血清和成像特征.
- 在一年的随访期分析RA-D2T的基线特征和治疗行为预测值.
主要方法:
- 采用横截面和前性研究设计,包括连续的类风湿性关节炎 (RA) 患者.
- 患者在基线和一年后使用多种评估工具进行了评估:DAS28,CDAI,SDAI,超声波 (美国) 和健康评估问卷 (HAQ).
- 使用后勤回归分析来确定RA-D2T的独立预测因素.
主要成果:
- 在基线时,27.5%的患者在所有评估参数中符合RA-D2T的标准. 贫血,高风湿因子 (RF) 标位和更高的HAQ分数独立地与RA-D2T相关.
- 一年后,RA-D2T的频率增加到33%. 像D2T-US (14%) 和D2T-HAQ (18.4%) 这样的特定指标显示出显著的流行率 (p < 0.001).
- 一年后RA-D2T的预测因素包括ACPA阳性 (OR:13.7) 和X射线侵蚀 (OR:2.9). 对于D2T-US,X射线侵蚀是一个强有力的预测因素 (OR:19.7).
结论:
- RA-D2T的频率因用于评估的客观参数 (分数,成像) 而有所不同.
- 基线特征,如ACPA阳性和放射性侵蚀,是持续难以治疗的RA的重要预测因素.
- 对于RA-D2T的治疗策略通常涉及传统的DMARDs,皮质类固醇和TNF阻断剂,JAK抑制剂经常用于治疗切换.
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