Sokka T, Willoughby J, Yazici Y, Pincus T
Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Clin Exp Rheumatol. 2003 Sep-Oct;21(5 Suppl 31):S146-53.
Several databases of patients with early rheumatoid arthritis (RA) have been established in the USA. The University of Tennessee at Memphis Cohort was organized in 1967-1971 to enroll 50 young adults (16-44 years) with symptom onset of < or = 6 months who met the 1958 American Rheumatism Association (ARA) criteria for at least probable RA. Two important observations from this database were that many patients seen within the first 6 months of meeting the criteria for probable RA have a self-limited rather than progressive disease, and that progressive disease is predicted by a high number of baseline swollen and tender joints. The National Institutes of Health (NIH) cohort of patients with peripheral synovitis for > or = 6 weeks but < 12 months in at least one peripheral joint was established in 1994. At the one-year follow-up, 45% of the patients met the RA criteria, 9% had reactive arthritis, 6% had psoriatic arthritis, 5% had other rheumatic diseases, and 35% had undifferentiated arthritis. The number of active joints, rather than meeting the criteria for RA, was the primary determinant of function and performance after one year. The Western Consortium of Practicing Rheumatologists (CPR) was established in 1993 to enroll patients with an RA duration < 1 year, positive rheumatoid factor, > or = 6 swollen and > or = 9 tender joints, and no previous treatment with disease modifying anti-rheumatic drugs (DMARDs). Data from this cohort indicated the validity of self-report joint counts. American College of Rheumatology 20% improvement (ACR20) responses were seen in 50% of patients at 6 months and in 57% of patients at 24 months, while antinuclear antibodies (ANA) were seen in 69% of patients prior to the availability of biologic agents. The North American Cohort of Patients with Early RA (SONORA), which included patients with symptoms for > 3 but < 12 months, indicated that methotrexate (MTX) was the most frequently prescribed DMARD, being taken by more than half the patients. The Consortium for the Longitudinal Evaluation of African-Americans with RA (CLEAR) registry and DNA repository has enrolled 123 African-American patients with early RA of less than 2 years' duration to analyze genetic and non-genetic factors associated with disease severity. The Early RA Treatment Evaluation Registry (ERATER) of patients with early RA (< 3 years) was established in 2001. In this registry, MTX was the first DMARD used in 83% of patients, and most patients would not meet the criteria for inclusion in recent clinical trials of biological agents. Further observation of recent cohorts of patients with early RA over the next decade should be informative regarding whether aggressive intervention strategies and new DMARDs and biologic agents lead to improved long-term outcomes.
美国已建立了几个早期类风湿关节炎（RA）患者数据库。孟菲斯田纳西大学队列于1967年至1971年组建，纳入了50名16至44岁、症状出现时间≤6个月且符合1958年美国风湿病协会（ARA）至少可能为RA标准的年轻成年人。该数据库的两项重要观察结果是，许多在符合可能RA标准的前6个月内就诊的患者患有自限性而非进行性疾病，并且进行性疾病可通过大量基线时肿胀和压痛关节来预测。美国国立卫生研究院（NIH）于1994年建立了一个队列，纳入至少一个外周关节出现外周滑膜炎≥6周但<12个月的患者。在一年随访时，45%的患者符合RA标准，9%患有反应性关节炎，6%患有银屑病关节炎，5%患有其他风湿性疾病，35%患有未分化关节炎。活跃关节的数量而非符合RA标准，是一年后功能和表现的主要决定因素。西方执业风湿病学家联盟（CPR）于1993年成立，纳入病程<1年、类风湿因子阳性、≥6个肿胀关节和≥9个压痛关节且既往未接受过改善病情抗风湿药物（DMARDs）治疗的患者。该队列的数据表明自我报告关节计数的有效性。6个月时50%的患者以及24个月时57%的患者出现美国风湿病学会20%改善（ACR20）反应，而在生物制剂可用之前，69%的患者检测到抗核抗体（ANA）。北美早期RA患者队列（SONORA）纳入症状出现时间>3个月但<12个月的患者，表明甲氨蝶呤（MTX）是最常处方的DMARD，超过一半的患者服用该药。非洲裔美国人RA纵向评估联盟（CLEAR）登记处和DNA储存库已纳入123名病程小于2年的非洲裔美国人早期RA患者，以分析与疾病严重程度相关的遗传和非遗传因素。早期RA治疗评估登记处（ERATER）于2001年建立，纳入早期RA（<3年）患者。在这个登记处，83%的患者首次使用的DMARD是MTX，并且大多数患者不符合近期生物制剂临床试验的纳入标准。在接下来的十年中，对近期早期RA患者队列的进一步观察对于积极干预策略以及新的DMARD和生物制剂是否能改善长期结局应具有参考价值。
