预测难以治疗的类风湿性关节炎的快速放射性进展:从长期随访的见解
Kerem Abacar1, Andrea Di Matteo1,2, Paula David3
1Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom.
Rheumatology (Oxford, England)
|October 1, 2025
概括
一半的多抗性类风湿性关节炎 (pr-RA) 患者表现出快速的放射性进展,表明需要积极治疗. 许多难以治疗的RA (D2T RA) 患者的进展缓慢,突出了异质性和需要有针对性的策略.
科学领域:
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
- 放射学 放射学是一门学科.
背景情况:
- 难以治疗的类风湿性关节炎 (D2T RA) 和多抗性RA (pr-RA) 代表了具有挑战性的患者子组.
- 了解长期放射性进展对于优化治疗策略至关重要.
研究的目的:
- 为了调查D2T RA和pr-RA患者的长期放射性进展.
- 评估基于超声波的分类 (持久性炎症耐火性RA [PIRRA]和非炎症耐火性RA [NIRRA]) 在预测快速放射性进展 (RRP) 中的实用性.
主要方法:
- 在114名D2T RA患者的平均随访9年期间,使用修改的夏普/范德海德 (mSvdH) 评分评估了放射性损伤.
- 使用超声波评估突炎来定义PIRRA和NIRRA子组.
- 分析了时间整合的C反应蛋白 (CRP) 和胀关节计数 (SJC) 对放射性进展的影响.
主要成果:
- 平均每年的mSvdH进展为2.8个单位.
- 与NIRRA患者 (2.4个单位) 相比,PIRRA患者的年放射性进展显著增加 (3.3个单位).
- 年龄较大和SJC较高独立地与RRP相关. 50%的pr-RA患者经历了RRP,而其他D2TRA病例的这一比例为19.4%.
结论:
- 一半的pr-RA患者表现出RRP,需要更积极的治疗方法.
- 许多D2T RA患者的放射性进展缓慢,这表明目前的治疗对一些患者是部分有效的.
- 在D2T RA中存在显著的异质性,需要量身定制的策略,特别是对于pr-RA子组.
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