难以治疗的类风湿性关节炎 (第一部分):对全球患病率的系统审查和元分析
Wenhui Xie1, Tong Chen1, Shiyu Xiao2
1Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China.
Annals of the rheumatic diseases
|November 4, 2025
概括
大约12%的类风湿性关节炎 (RA) 患者患有难以治疗的RA (D2T-RA),近一半的患者表现出持续的炎症. 更严格的标准确定了需要新疗法的患者.
科学领域:
- 类风湿病学 类风湿病学
- 临床流行病学 临床流行病学
背景情况:
- 难以治疗的类风湿性关节炎 (D2T-RA) 尽管有针对性的治疗方法取得了进展,但仍构成了重大临床挑战.
- 欧洲反风湿联盟 (EULAR) 提供了D2T-RA的定义,但全球流行数据有限.
研究的目的:
- 使用EULAR定义系统评估D2T-RA的全球流行情况.
- 确定D2T-RA病例中可归因于持久性炎性耐炎性类风湿性关节炎 (RA) 的比例.
主要方法:
- 在PubMed,EMBASE和Cochrane图书馆进行了全面的文献搜索,截至2025年4月.
- 包括了根据EULAR定义报告D2T-RA患病率的观察性研究.
- 随机效应的比例元分析被用来计算聚合的流行率.
主要成果:
- 分析了23项研究,其中包括来自13个国家的27,987名RA患者.
- 全球D2T-RA的综合流行率为11.7% (95%CI:9.5%-14.3%).
- 几乎一半的D2T-RA患者 (47.1%) 呈现持续性炎症耐药性RA,并且随着更严格的治疗失败定义,患病率下降.
结论:
- 在全球范围内,约有12%的类风湿性关节炎患者符合D2T-RA标准,其中很大一部分患有持续性炎症性疾病.
- 更严格的定义,例如三种或更多种生物/向合成修饰疾病的抗风湿药物 (b/tsDMARDs) 的失败,确定了需要创新的治疗策略的特定子组.
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