van der Heijde D M, van Riel P L, van Leeuwen M A, van 't Hof M A, van Rijswijk M H, van de Putte L B
Department of Rheumatology, University Hospital Nijmegen, The Netherlands.
Br J Rheumatol. 1992 Aug;31(8):519-25. doi: 10.1093/rheumatology/31.8.519.
We studied the influence of demographic, clinical, laboratory and genetic features and radiographic damage at onset on the outcome after 2 years in a prospective study of 147 patients with classical or definite RA with disease duration shorter than 1 year at entry. Outcome was determined by physical disability and by radiographic damage of hands and feet. By means of multiple regression analysis and discriminant analysis outcome was explained from variables at the start and during the first 6 months. No clinically relevant conclusions could be made for physical disability due to the low explained variance and small number of patients with bad physical disability. Radiographic damage after 2 years was predicted by high disease activity at the start (measured as erythrocyte sedimentation rate, C-reactive protein or Disease Activity Score) combined with DR4 or DR2 (as a prognostically favourable factor) and rheumatoid factor positivity. Radiographic damage could be better predicted if disease activity during the first 6 months was included. Absence or presence of progression of radiographic damage could be correctly predicted in 83% of the patients.
我们在一项前瞻性研究中，对147例疾病病程短于1年的典型或确诊类风湿关节炎（RA）患者进行了研究，观察人口统计学、临床、实验室及基因特征以及发病时的影像学损害对2年后预后的影响。预后由身体残疾情况以及手足的影像学损害来判定。通过多元回归分析和判别分析，从疾病起始及最初6个月时的变量来解释预后情况。由于可解释的方差较低且身体残疾严重的患者数量较少，因此对于身体残疾无法得出具有临床意义的结论。2年后的影像学损害可通过发病时的高疾病活动度（以红细胞沉降率、C反应蛋白或疾病活动评分衡量）、DR4或DR2（作为预后有利因素）以及类风湿因子阳性来预测。如果纳入最初6个月时的疾病活动度，则对影像学损害的预测效果更佳。在83%的患者中能够正确预测影像学损害是否进展。
