Prediction of flare following glucocorticoids withdrawal in rheumatoid arthritis patients with continuation of csDMARDs: a real-life study
Prediction of flare following glucocorticoids withdrawal in rheumatoid arthritis patients with continuation of csDMARDs: a real-life study
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DOI：
10.1007/s11739-023-03362-0
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发表时间：
2023-07-07
影响因子：
4.6
通讯作者：
Zhang，Zhuoli
中科院分区：
文献类型：
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作者：
Xie，Wenhui;Huang，Hong;Zhang，Zhuoli
目的 确定接受传统合成疾病缓解抗风湿药物 (csDMARD) 的类风湿关节炎 (RA) 患者在糖皮质激素 (GC) 停药后出现病情复发的危险因素。方法从纵向真实世界队列中选择停止 GC 并继续使用 csDMARD 的 RA 患者。确诊的 RA 定义为疾病持续时间超过 12 个月。 RA控制不满意被定义为基于简化疾病活动指数（SDAI）的缓解时间占从GC开始到停止的总时间的比例小于50%。采用Logistic回归分析GC停止后复发的独立危险因素，结果以比值比（OR）表示。结果有115名符合条件的RA患者在继续csDMARDs的情况下放弃GC（甲氨蝶呤：80％；羟氯喹：61％；csDMARDs组合：79％）。其中 24 名患者在 GC 停止后出现病情复发。与无复发患者相比，发作患者更有可能出现 RA（75% vs 49%，p= 0.025）、更高的中位累积泼尼松龙剂量（3.3 vs 2.2 g，p= 0.004），并且在 GC 使用期间对 RA 控制不满意的比例更高（66% vs 33%，p= 0.038）。在多变量分析中，确定的 RA (OR 2.93 [1.02–8.43])、累积泼尼松龙剂量 > 2.5 g (OR 3.69 [1.34–10.19]) 和不满意的 RA 控制 (OR 3.00 [1.09–8.30]) 预测耀斑风险显着增加。随着危险因素数量的增加，急性发作风险也随之增加，在具有三种危险因素的患者中，最高 OR 为 11.56（p 趋势 = 0.002）。结论 GC 停药后的急性发作在接受 csDMARD 治疗的 RA 患者中并不常见。 GC 停药前已确定的 RA、GC 累积剂量较高以及 RA 控制不满意是 GC 停药后复发的重要因素。
ObjectiveTo determine the risk factors for flare after glucocorticoids (GC) withdrawal in rheumatoid arthritis (RA) patients with undergoing conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs).MethodsRA patients who discontinued GC with continuation of csDMARD were selected from a longitudinal real-world cohort. Established RA was defined as disease duration over 12 months. Dissatisfied RA control was defined as the proportion of simplified disease activity index (SDAI)-based remission time to total time from GC initiation to discontinuation less than 50%. Logistic regression was used to analyze the independent risk factors for flare after GC discontinuation and results were expressed as odds ratio (OR).ResultsThere were 115 eligible RA patients discounted GC with continuation of csDMARDs (methotrexate: 80%; hydroxychloroquine: 61%; csDMARDs combination: 79%). Of these, 24 patients experienced flare after GC discontinuation. Compared with relapse-free patients, flare patients were more likely to have established RA (75% vs 49%,p= 0.025), higher median cumulative prednisolone dosages (3.3 vs 2.2 g,p= 0.004), and higher proportion of dissatisfied RA control during GC usage (66% vs 33%,p= 0.038). In multivariate analysis, significantly increased flare risk was predicted by established RA (OR 2.93 [1.02–8.43]), cumulative prednisolone dose > 2.5 g (OR 3.69 [1.34–10.19]) and dissatisfied RA control (OR 3.00 [1.09–8.30]). Flare risk was increased with increases in number of risk factors with highest OR of 11.56 in patients with three risk factors (pfor trend = 0.002).ConclusionsFlare following GC withdrawal is not common in RA patients with undergoing csDMARDs therapy. Established RA, higher cumulative GC dose and dissatisfied RA control before GC discontinuation are important factors associated with flare after GC withdrawal.