Defining refractory rheumatoid arthritis
Defining refractory rheumatoid arthritis
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DOI：
10.1136/annrheumdis-2017-212862
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发表时间：
2018-07-01
影响因子：
27.4
通讯作者：
Buch, Maya H.
中科院分区：
文献类型：
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作者：
Buch, Maya H.
虽然生物疾病缓解抗风湿药物（bDMARD）已经改变了类风湿关节炎（RA）患者的结局，但仍有一部分患者对多种bDMARD难以治疗。迄今为止，难治性RA的定义是任意的，并且这些队列的结果数据和影响仍然有限。从随机对照试验和一些现实生活数据中推断，约20%的患者进展到第三种bDMARD，更适度的比例未能通过额外的bDMARD。这一观点讨论了难治性RA疾病的观点，并提出了准确识别难治性队列的关键原则。这些包括证明存在持续性炎症，尽管有多种治疗，并承认抗药抗体的发展。对难治性疾病的潜在基础进行了总结，并对今后难治性疾病的初步评价提出了建议。对难治性RA疾病的具体研究是必要的，以告知临床需求，并为潜在机制的可靠研究提供基础。
While biologic disease-modifying antirheumatic drugs (bDMARDs) have transformed outcomes of people with rheumatoid arthritis (RA), a proportion of patients are refractory to multiple bDMARDs. Definitions of refractory RA thus far have been arbitrary, and outcome data and impact of such cohorts remain limited. Extrapolation from randomised controlled trial and some real-life data suggest approximately 20% progress onto a third bDMARD with a more modest proportion failing additional bDMARDs. This viewpoint discusses an opinion of refractory RA disease and proposes key principles to accurately identify refractory cohorts. These include demonstrating presence of persistent inflammation despite multiple therapies and acknowledging development of antidrug antibody. Potential basis of refractory disease is summarised, and suggestions for an initial approach in the future evaluation of refractory disease are offered. Specific investigation of refractory RA disease is necessary to inform the clinical need and provide a basis for robust investigation of underlying mechanisms.