Quinn Mark A, Green Michael J, Marzo-Ortega Helena, Proudman Susanna, Karim Zunaid, Wakefield Richard J, Conaghan Philip G, Emery Paul
Royal Adelaide Hospital, Adelaide, Australia.
Arthritis Rheum. 2003 Nov;48(11):3039-45. doi: 10.1002/art.11269.
Inflammatory arthritis of the hands is a frequent clinical presentation with a variable outcome. Patients not satisfying the classification criteria for recognized arthritides are described as having undifferentiated inflammatory arthritis, for which there are no accepted therapeutic algorithms. This study assessed the clinical outcome of patients with undifferentiated arthritis of the hands after use of a treatment algorithm, and evaluated the prognostic features in these patients.
One hundred consecutive patients with undifferentiated arthritis of the hands were assessed following use of a pragmatic treatment algorithm that was based on clinical presentation and response to treatment. The following standard step-up treatment protocol was used: 1) nonsteroidal antiinflammatory drugs (NSAIDs), 2) a single dose of corticosteroid administered by either intramuscular or intraarticular injection, and 3) disease-modifying antirheumatic drugs (DMARDs). Patients with specific rheumatologic diagnoses were excluded. The primary outcome was persistence of synovitis at 12 months.
Seventy-eight percent of patients received NSAIDs, 72% received corticosteroids, and 30% received DMARD therapy. Among patients who had synovitis at 12 months, the prevalence of rheumatoid factor (RF) seropositivity, swollen joints, and synovitis at baseline was greater than in those without persistent synovitis. Logistic regression analysis showed baseline investigations to be poor predictors of subsequent DMARD use, with the best predictor being persistence of synovitis at 12 weeks. Rheumatoid arthritis (RA) developed in 14 patients. Logistic regression analysis showed that significant predictors of RA were RF seropositivity and the painful joint count at baseline. No patient who experienced resolution of synovitis by 12 weeks had persistent synovitis that subsequently required DMARD therapy. Only 13% of patients entered remission. Early resolution of synovitis was associated with an excellent prognosis.
Undifferentiated arthritis of the hands is not a benign condition, with 30% of patients receiving DMARD therapy by 12 months and low remission rates. Results of the clinical assessment at 12 weeks is the single best predictor of future therapy. This study provides background data for use in determining future therapeutic interventions.
手部炎性关节炎是一种常见的临床表现，其预后各不相同。不符合公认关节炎分类标准的患者被描述为患有未分化炎性关节炎，对此尚无公认的治疗方案。本研究评估了采用一种治疗方案后手部未分化关节炎患者的临床结局，并评估了这些患者的预后特征。
对连续100例手部未分化关节炎患者采用基于临床表现和治疗反应的实用治疗方案进行评估。采用以下标准的逐步治疗方案：1）非甾体抗炎药（NSAIDs），2）单次肌内或关节内注射皮质类固醇，3）改善病情抗风湿药（DMARDs）。排除有特定风湿性诊断的患者。主要结局是12个月时滑膜炎的持续存在。
78%的患者接受了NSAIDs治疗，72%接受了皮质类固醇治疗，30%接受了DMARD治疗。在12个月时有滑膜炎的患者中，类风湿因子（RF）血清阳性、关节肿胀和基线时滑膜炎的患病率高于无持续性滑膜炎的患者。逻辑回归分析显示，基线检查对随后使用DMARD的预测能力较差，最佳预测因素是12周时滑膜炎的持续存在。14例患者发展为类风湿关节炎（RA）。逻辑回归分析显示，RA的显著预测因素是RF血清阳性和基线时疼痛关节数。在12周时滑膜炎得到缓解的患者中，没有患者随后出现需要DMARD治疗的持续性滑膜炎。只有13%的患者进入缓解期。滑膜炎的早期缓解与良好的预后相关。
手部未分化关节炎并非良性疾病，到12个月时30%的患者接受了DMARD治疗，缓解率较低。12周时的临床评估结果是未来治疗的最佳单一预测因素。本研究为确定未来的治疗干预措施提供了背景数据。
