在现实生活条件下，高滴度类风湿因子与较差的临床结果和对先进治疗方法的更高需求相关。

IF 2.9 3区医学 Q2 RHEUMATOLOGY Rheumatology and Therapy Pub Date : 2025-02-01 Epub Date: 2024-12-19 DOI:10.1007/s40744-024-00730-w

Victor Davi R S Oliveira, Ana Paula M G Reis, Claiton V Brenol, Ivânio A Pereira, Karina R Bonfiglioli, Letícia R Pereira, Manoel B Bértolo, Maria de Fátima L C Sauma, Maria Fernanda B R Guimarães, Paulo Louzada-Júnior, Rina D N Giorgi, Sebastião C Radominski, Licia Maria H Mota, Cleandro P Albuquerque, Geraldo R Castelar-Pinheiro

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引用次数: 0

摘要

类风湿因子（RF）在类风湿关节炎（RA）病理生理中起重要作用，但不同RF滴度的差异效应仍未得到充分研究。我们评估了不同RF滴度与长期RA临床结果之间的关系。方法：这项多中心横断面研究纳入了符合ACR/EULAR (2010) RA标准的成年人。评估循环射频滴度和临床流行病学特征。进行了双变量（Student’st检验和卡方检验）检验以及多元逻辑回归和线性回归分析。结果：纳入1097名受试者；78.7%为RF阳性，56.2%为高滴度（≥3倍正常上限）。阴性RF组与低阳性RF组在所有临床结果方面表现相似，随后被汇总为“非高”RF组。高射频滴度（与“非高滴度”相比）与烟草使用相关(优势比，OR[95%置信区间，CI]: 2.04 [1.35, 3.08]；p 2;p = 0.033)。在多因素分析中，高滴度RF与较高的疾病活动性（临床疾病活动性指数，CDAI: β = 2.44 [0.89, 3.99], p = 0.002）、较差的功能能力（健康评估问卷残疾指数，HAQ-DI: β = 0.112 [0.018, 0.205], p = 0.020）独立相关；关节外表现（OR 1.48 [1.09, 2.00], p = 0.011）；皮质类固醇（OR 1.53 [1.19, 1.96], p = 0.001）和生物疾病缓解抗风湿药物（bDMARD）使用增加（OR 1.41 [1.08, 1.84], p = 0.011）。结论：长期RA患者的高RF滴度与疾病活动性恶化、身体功能降低、关节外表现增加以及皮质类固醇和bDMARDs的使用增加相关。比较RF高滴度和非高滴度（而不是RF阳性滴度和RF阴性滴度）似乎对评估RF在RA中的临床效果更有用。这种方法应该在未来的射频研究中加以考虑。

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High-Titer Rheumatoid Factor is Associated with Worse Clinical Outcomes and Higher Needs for Advanced Therapies in Rheumatoid Arthritis Under Real-Life Conditions.

Introduction: Rheumatoid factor (RF) plays an important role in rheumatoid arthritis (RA) pathophysiology, yet the differential effects of varying RF titers remain understudied. We evaluated associations between different RF titers and clinical outcomes in long-standing RA.

Methods: This multicenter, cross-sectional study included adults meeting ACR/EULAR (2010) criteria for RA. Circulating RF titers and clinical-epidemiological characteristics were evaluated. Bivariate (Student's t and chi-squared tests) tests and multiple logistic and linear regression analyses were conducted.

Results: We included 1097 participants; 78.7% had positive RF, with high titers (≥ 3 × the upper limit of normality) in 56.2%. Negative vs. low-positive RF groups performed similarly concerning all clinical outcomes, being subsequently aggregated as "non-high" RF group. High RF titers (compared to "non-high") were associated with tobacco use (odds ratio, OR [95% confidence interval, CI]: 2.04 [1.35, 3.08]; p < 0.001), multiraciality (OR [95% CI] 1.31 [1.03, 1.67]; p = 0.028, compared to White race), and higher body mass index (mean difference [95% CI] 0.69 [0.05, 1.33] kg/m²; p = 0.033). In multivariate analyses, high-titer RF was independently associated with higher disease activity (Clinical Disease Activity Index, CDAI: β = 2.44 [0.89, 3.99], p = 0.002), worse functional capacity (Health Assessment Questionnaire Disability Index, HAQ-DI: β = 0.112 [0.018, 0.205], p = 0.020); extra-articular manifestations (OR 1.48 [1.09, 2.00], p = 0.011); increased corticosteroid (OR 1.53 [1.19, 1.96], p = 0.001) and biological disease-modifying antirheumatic drugs (bDMARD) use (OR 1.41 [1.08, 1.84], p = 0.011).

Conclusions: High RF titers in long-standing RA were associated with worse disease activity, lower physical functionality, increased extra-articular manifestations, and higher usage of corticosteroids and bDMARDs. Comparing high vs. non-high RF titers (rather than positive vs. negative RF) seems more useful for evaluating the clinical effects of RF in RA. This approach should be considered in future studies of RF.

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来源期刊

Rheumatology and Therapy RHEUMATOLOGY-

CiteScore

6.00

自引率

5.30%

发文量

审稿时长

6 weeks

期刊介绍： Aims and Scope Rheumatology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of rheumatologic therapies. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed. Areas of focus include, but are not limited to, rheumatoid arthritis, gout, gouty arthritis, psoriatic arthritis, osteoarthritis, juvenile idiopathic/rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis, Pompe’s disease, inflammatory joint conditions, musculoskeletal conditions, systemic sclerosis, and fibromyalgia. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial protocols, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Rheumatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research. Ethics and Disclosures The journal is a member of the Committee on Publication Ethics (COPE) and subscribes to its principles on how to deal with acts of misconduct thereby committing to investigate allegations of misconduct in order to ensure the integrity of research. Content in this journal is peer-reviewed (Single-blind). 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