预测风湿性关节炎患者在生物诱导缓解,缩和稳定疗法下预测爆发
Hanna Gul1, Andrea Di Matteo2, Innocent Anioke1
1University of Leeds, Leeds, UK.
ACR open rheumatology
|February 27, 2024
概括
在缓解期的类风湿性关节炎 (RA) 患者中,减弱生物修饰性抗风湿药 (b-DMARDs) 可能导致发作,由较低调节性T细胞 (Tregs) 和炎症生物标志物预测. 识别这些预测因素可以指导治疗决策.
科学领域:
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 生物修饰性抗风湿药物 (b-DMARD) 治疗是常见的类风湿性关节炎 (RA) 患者在稳定缓解.
- 目前的指导方针缺乏在RA患者中成功逐渐减少b-DMARDs的具体策略.
- 识别爆发的预测因素对于管理RA治疗停药至关重要.
研究的目的:
- 为了确定类风湿性关节炎 (RA) 患者疾病爆发的预测因素,患者接受稳定的b-DMARD治疗逐渐减缓.
- 为了比较b-DMARDs逐渐减少的患者和稳定治疗的患者之间的爆发率.
- 评估临床,超声波,免疫学和患者报告结果在预测爆发中的作用.
主要方法:
- 招募了持续缓解的RA患者 (DAS28-CRP<2.6长达≥6个月).
- 收集的数据包括临床评估,超声波 (US) 与功率多普勒 (PD),CD4+T细胞子集和患者报告的结果 (PRO).
- 后勤回归确定了爆发预测因素;风险分层使用了AUROC分析.
主要成果:
- 在b-DMARDs逐渐减少的患者中,发作发生在37%的患者中,而在稳定治疗中为20% (P=0.043).
- 在逐渐减少组中,爆发与较低调节性T细胞 (Tregs) 和较高的CRP,ESR和炎症相关细胞 (IRC) 相关.
- 逐渐减缓组的爆发预测模型包括Tregs,IRCs和CRP (81.7%的准确率);在持续治疗组中,疼痛关节计数,美国PD和疼痛得分具有预测性 (82.1%的准确率).
结论:
- 下Tregs和升高的炎症生物标志物 (IRCs/CRP) 预测在RA中b-DMARD逐渐缩小期间的爆发.
- 疼痛参数和超声波炎症预测在继续b-DMARD治疗的患者中爆发.
- 生物标志物知识可以优化b-DMARD逐渐选择,并指导持续治疗的患者的监测.
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