To investigate the clinical phenotype and treatment response in patients with rheumatoid arthritis (RA) with and without concomitant Sjögren’s disease (SjD). In this observational cohort study, patients with RA from the Swiss Clinical Quality Management in Rheumatic Diseases registry were categorised according to the presence or absence of SjD. To assess treatment effectiveness, drug retention of tumor necrosis factor-α-inhibitors (TNFi) was compared to other mode of action (OMA) biologics and Janus kinase-inhibitors (JAKi) in RA patients with and without SjD. Adjusted hazard ratios (HR) for time to drug discontinuation were compared in crude and adjusted Cox proportional regression models for potential confounders. We identified 5974 patients without and 337 patients with concomitant SjD. Patients with SjD were more likely to be female, to have a positive rheumatoid factor, higher disease activity scores, and erosive bone damage. For treatment response, a total of 6781 treatment courses were analysed. After one year, patients with concomitant SjD were less likely to reach DAS28 remission with all three treatment modalities. Patients with concomitant SjD had a higher hazard for stopping TNFi treatment (adjusted HR 1.3 [95% CI 1.07–1.6]; OMA HR 1.12 [0.91–1.37]; JAKi HR 0.97 [0.62–1.53]). When compared to TNFi, patients with concomitant SjD had a significantly lower hazard for stopping treatment with OMA (adjusted HR 0.62 [95% CI 0.46–0.84]) and JAKi (HR 0.52 [0.28–0.96]). RA patients with concomitant SjD reveal a severe RA phenotype, are less responsive to treatment, and more likely to fail TNFi.

中文翻译：

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伴随干燥病作为类风湿性关节炎治疗效果的生物标志物 - 来自瑞士临床质量管理队列的结果

旨在调查伴有或不伴有干燥病 (SjD) 的类风湿性关节炎 (RA) 患者的临床表型和治疗反应。在这项观察性队列研究中，瑞士风湿病临床质量管理登记处的 RA 患者根据是否存在 SjD 进行分类。为了评估治疗效果，将肿瘤坏死因子-α 抑制剂 (TNFi) 与其他作用模式 (OMA) 生物制剂和 Janus 激酶抑制剂 (JAKi) 在患有和不患有 SjD 的 RA 患者中的药物保留进行了比较。在粗略和调整后的 Cox 比例回归模型中比较了停药时间的调整后风险比 (HR)，以找出潜在的混杂因素。我们确定了 5974 名没有 SjD 的患者和 337 名伴有 SjD 的患者。SjD 患者更有可能是女性，类风湿因子呈阳性，疾病活动评分较高，且有侵蚀性骨损伤。对于治疗反应，总共分析了 6781 个疗程。一年后，合并 SjD 的患者采用所有三种治疗方式达到 DAS28 缓解的可能性较小。合并 SjD 的患者停止 TNFi 治疗的风险较高（调整后 HR 1.3 [95% CI 1.07–1.6]；OMA HR 1.12 [0.91–1.37]；JAKi HR 0.97 [0.62–1.53]）。与 TNFi 相比，伴有 SjD 的患者停止使用 OMA（调整后 HR 0.62 [95% CI 0.46–0.84]）和 JAKi（HR 0.52 [0.28–0.96]）治疗的风险显着降低。伴有 SjD 的 RA 患者表现出严重的 RA 表型，对治疗的反应较差，并且更有可能 TNFi 失败。