风湿性关节炎的性别差异:从临床和患者报告的结果角度的新见解
Gonul Hazal Koc1, Agnes E M Looijen2, Irene E van der Horst-Bruinsma3
1G.H. Koc, MD, Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands.
The Journal of rheumatology
|March 5, 2025
概括
女性类风湿性关节炎 (RA) 患者经历了较高的疾病活性和功能障碍,需要更多的生物疾病修饰性抗风湿药物 (bDMARDs). 这些发现凸显了对性别特定的RA管理策略的需要.
科学领域:
- 类风湿病学 类风湿病学
- 临床免疫学临床免疫学
- 流行病学 流行病学
背景情况:
- 人们对类风湿性关节炎 (RA) 病程和疾病负担的性别差异知之甚少.
- 现有的关于RA结果的性别差异数据有限,并且往往是矛盾的.
研究的目的:
- 调查随着时间的推移,类风湿性关节炎 (RA) 中临床和患者报告结果 (PRO) 的基于性别的差异.
- 评估T2T (治疗到目标) 方法对女性与男性患者的RA管理的影响.
主要方法:
- 分析了286名女性和139名男性RA患者在鹿特丹早期关节炎队列 (tREACH) 试验中的治疗.
- 评估临床结果,包括疾病活性 (DAS44),药物使用 (DMARD,bDMARD),持续无DMARD缓解 (SDFR) 和放射性进展.
- 评估一般健康,疼痛,功能能力 (HAQ-DI),生活质量,疲劳,生产力损失和心理健康等PRO,使用针对混因素调整的混合模型.
主要成果:
- 随着时间的推移,女性RA患者的DAS44得分更高 (β=0.36,P<0.001) 和对bDMARDs的需求增加 (36%对24%,P<0.001).
- 两性之间没有观察到SDFR或放射性进展的显著差异.
- 用HAQ-DI测量的功能能力在调整混因子后,女性的功能能力明显差 (β=0.10,P<0.001).
结论:
- 尽管T2T方法改善了结果,但女性RA患者表现出更高的疾病活性和功能障碍.
- 女人需要更多的bDMARDs,它们的疗效似乎较低.
- 这些性别特异性差异强调了针对类风湿性关节炎进行量身定制的治疗建议的必要性.
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