The current EULAR definition of difficult-to-treat rheumatoid arthritis (D2T-RA) identifies patients with active disease refractory to multiple treatments at a single time point, without considering the persistence of this condition over time. The study aimed to assess difficult-to-treat rheumatoid arthritis (D2T-RA) over 12 months, considering persistence over time rather than a single time point, in a real-life cohort. In a single-center real-life cohort, demographic and clinic data were cross-sectionally collected for each patient at baseline and retrospectively over the previous 12 months bimonthly. For each timepoint, the prevalence of D2T-RA patients was calculated, and patients meeting the EULAR definition for at least 6 months were defined as persistent D2T-RA (pD2T-RA). Finally, the clinical characteristics associated with the time-based definition of pD2T-RA were analyzed. Among 610 adult RA patients, 104 were refractory to ≥ 2 treatments. Initially, 41.3% met D2T-RA criteria, but only 27.9% fulfilled persistent D2T-RA (pD2T-RA) criteria over 6 months. The pD2T-RA group was associated with male gender, higher HAQ and Charlson Comorbidity Index scores, more failed treatments, and use of non-NSAID analgesics. Logistic regression linked pD2T-RA to higher SDAI and CRP values, and the use of glucocorticoids or analgesics. Chronic use of glucocorticoids was strongly associated with pD2T-RA. The application of a temporal criterion allowed for the selection of a subgroup of pD2T-RA patients who differ from those who meet the definition of D2T-RA only episodically. Chronic use of glucocorticoids was the factor most strongly associated with pD2T-RA status. What is already known about this subject? Since the institution of the D2T-RA definition, many efforts have been made to characterize this subpopulation's prevalence as well as clinical and demographical features. However, no studies have so far faced the temporal maintenance of the D2T-RA status. What does this study add? A definition of persistent or episodic D2T-RA is proposed according to the temporal trajectory of D2T-RA status, resulting in approximately 27% of D2T-RA patients persistently fulfilling the pD2T-RA definition. At each single time point, one-third of D2T-RA patients are represented by episodic D2T-RA patients. How might this impact on clinical practice? Persistent D2T-RA definition may serve to further homogenize the D2T-RA population.

中文翻译：

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时间揭开的真相与D2T-RA的大理石定义：难治性RA患者难治状态持续存在的回顾性分析


当前 EULAR 对难治性类风湿性关节炎 (D2T-RA) 的定义是指患有活动性疾病且在单个时间点多次治疗难以治愈的患者，而没有考虑这种情况随时间的持续存在。该研究旨在评估现实生活中的难治性类风湿性关节炎 (D2T-RA) 超过 12 个月的时间，考虑随着时间的推移而不是单个时间点的持续性。在单中心现实生活队列中，在基线时对每位患者进行横断面人口统计和临床数据收集，并每两个月回顾一次过去 12 个月的数据。对于每个时间点，计算D2T-RA患者的患病率，并且满足EULAR定义至少6个月的患者被定义为持续性D2T-RA（pD2T-RA）。最后，分析了与 pD2T-RA 基于时间的定义相关的临床特征。在 610 名成年 RA 患者中，104 名患者对 ≥ 2 种治疗无效。最初，41.3% 符合 D2T-RA 标准，但只有 27.9% 满足 6 个月以上持续 D2T-RA (pD2T-RA) 标准。 pD2T-RA 组与男性、较高的 HAQ 和查尔森合并症指数评分、更多失败的治疗以及使用非 NSAID 镇痛药相关。 Logistic 回归将 pD2T-RA 与较高的 SDAI 和 CRP 值以及糖皮质激素或镇痛药的使用联系起来。长期使用糖皮质激素与 pD2T-RA 密切相关。时间标准的应用允许选择 pD2T-RA 患者亚组，这些患者与仅偶尔满足 D2T-RA 定义的患者不同。长期使用糖皮质激素是与 pD2T-RA 状态最密切相关的因素。关于这个主题已经知道了什么？ 自制定 D2T-RA 定义以来，人们已做出许多努力来描述该亚群的患病率以及临床和人口统计特征。然而，迄今为止，还没有研究面临 D2T-RA 状态的暂时维持。这项研究增加了什么？根据 D2T-RA 状态的时间轨迹提出持续性或偶发性 D2T-RA 的定义，导致大约 27% 的 D2T-RA 患者持续满足 pD2T-RA 定义。在每个单一时间点，三分之一的 D2T-RA 患者是偶发性 D2T-RA 患者。这对临床实践有何影响？持续的 D2T-RA 定义可能有助于进一步同质化 D2T-RA 群体。