免疫介导的皮肤损伤与生物疾病修饰抗风湿病药物相关:一项在三级中心22年的经验。

IF 1.4 4区 医学 Q3 RHEUMATOLOGY ARP Rheumatology Pub Date : 2023-07-19
Ana Martins, Daniela Oliveira, Frederico Rajão Martins, Rafaela Nicolau, Filipe Oliveira Pinheiro, Maria Seabra Rato, Sofia Pimenta, Lúcia Costa, Miguel Bernardes
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引用次数: 0

摘要

引言:免疫介导的皮肤损伤(IMSL)可能会导致治疗中断。尽管这些病变以前很少被描述,但真正的发病率尚不清楚。目的:在一个大型慢性炎性风湿性疾病患者队列中,探讨与bDMARD相关的IMSL的累积发病率、管理和结果。探讨IMSL发展的可能关联和风险因素。方法:对接受至少一种bDMARD治疗至少6个月的类风湿性关节炎(RA)、脊柱炎(SpA)和银屑病关节炎(PsA)患者进行回顾性单中心研究。收集与bDMARD特征和结果相关的IMSL。结果:共纳入989例RA、SpA和PsA患者。27名患者(2.7%)表现出可能与bMARD相关的IMSL,其中银屑病是最常见的IMSL(n=12,44.4%),其次是药物诱导的红斑狼疮(n=6)、斑秃(n=3)和白细胞碎屑血管炎(n=2)。IMSL导致27名患者中有18名(66.7%)退出bDMARD。患有IMSL的患者在诊断时年龄较小(p=0.038),病程较长(p=0.018),bDMARD治疗持续时间较长(p=0.008),既往bDMARD数量较高(p<0.001)。在IMSL患者组中,接受阿达木单抗治疗的患者比例显著较高(p<0.001)。在多变量回归模型中,既往bDMARD(OR 2.13,95%CI 1.47-3.10,p<0.001,)和阿达木单抗(OR 4.60,95%CI 1.96-10.80,p<001)的数量是IMSL发展的统计学显著预测因素。结论:在我们的研究中,与bDMARD相关的IMSL的累计发病率估计为2.7%。诊断年龄越小、疾病持续时间越长、bDMARD治疗持续时间越久、既往bDMARD次数越多以及阿达木单抗治疗与IMSL发展风险增加独立相关。
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Immune-mediated skin lesions related to biological disease-modifying antirheumatic drugs: a 22-year experience of a tertiary center.

Introduction: Immune-mediated skin lesions (IMSL) can be very disabling leading to treatment discontinuation. Although these lesions have rarely been previously described, the true incidence is unknown.

Objective: To explore the cumulative incidence, management and outcomes of IMSL related to bDMARD in a large cohort of patients with chronic inflammatory rheumatic diseases. To explore possible associations and risk factors for IMSL development.

Methods: A retrospective single-center study of patients with rheumatoid arthritis (RA), spondylarthritis (SpA) and psoriatic arthritis (PsA) that had been treated with at least one bDMARD for at least 6 months was conducted. IMSL related to bDMARD characteristics and outcomes were collected.

Results: A total of 989 patients with RA, SpA and PsA were included. Twenty-seven patients (2.7%) presented IMSL potentially related to bDMARD, being psoriasis the most common IMSL (n=12, 44.4%), followed by drug-induced lupus erythematosus (n=6), alopecia areata (n=3) and leukocytoclastic vasculitis (n=2). IMSL led to withdrawal of bDMARD in 18 of the 27 patients (66.7%). Patients with IMSL had younger age at diagnosis (p=0.038), longer disease duration (p=0.018), longer duration of bDMARD treatment (p=0.008), and higher number of previous bDMARDs (p < 0.001) than patients without IMSL. In the group of patients with IMSL there was a significantly higher percentage of patients treated with adalimumab (p < 0.001). In multivariate regression model, the number of previous bDMARDs (OR 2.13, 95%CI 1.47-3.10, p < 0.001) and treatment with adalimumab (OR 4.60, 95%CI 1.96-10.80 , p < 0.001) were statistically significant predictive factors for IMSL development.

Conclusion: In our study, IMSL related to bDMARDs had an estimated cumulative incidence of 2.7%. Younger age at diagnosis, longer disease duration, longer duration of bDMARD treatment, higher number of previous bDMARDs and treatment with adalimumab were independently associated with an increased risk of IMSL development.

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