Bakker M F, Jacobs J W G, Verstappen S M M, Bijlsma J W J
University Medical Center Utrecht, Department of Rheumatology & Clinical Immunology, F02.127, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Ann Rheum Dis. 2007 Nov;66 Suppl 3(Suppl 3):iii56-60. doi: 10.1136/ard.2007.078360.
To evaluate the available evidence on the efficacy and feasibility of the new concept of tight control in randomised trials in patients with rheumatoid arthritis (RA). Tight control is a treatment strategy tailored to the individual patient with RA, which aims to achieve a predefined level of low disease activity or remission within a certain period of time.
The literature database PubMed was searched and yielded four trials: the FIN-RACo trial, the TICORA study, the BeSt study and the CAMERA study.
Tight control resulted in greater improvement and a higher percentage of patients meeting the preset aim of low disease activity or remission when compared to the control intervention. In the FIN-RACo trial, analysing the subset of patients completing the study, 68% in the tight control group achieved remission (DAS28<2.6) verus 41% in the contrast group [corrected] In the TICORA study, 65% of patients in the tight control group versus 16% of the contrast group achieved remission, based on DAS<1.6 (p<0.0001). In the CAMERA study, 50% of patients in the tight control group using a computer decision model achieved remission, versus 37% in the contrast group (p = 0.029). The BeSt study consisted of only tight control groups aimed at a DAS<1.6; remission was achieved in 38-46% of patients. This is higher than the range of remission in earlier trials of 13-36%.
Tight control aiming for low disease activity or even better still, remission, seems a promising option in treating patients with RA in clinical trials and probably also in daily practice.
评估类风湿关节炎（RA）患者随机试验中严格控制这一新概念的疗效和可行性的现有证据。严格控制是一种针对RA个体患者量身定制的治疗策略，旨在在一定时间内达到预定的低疾病活动水平或缓解状态。
检索文献数据库PubMed，获得四项试验：芬兰类风湿关节炎控制（FIN-RACo）试验、类风湿关节炎强化治疗与传统治疗对照研究（TICORA）研究、最佳治疗策略（BeSt）研究和计算机辅助治疗类风湿关节炎（CAMERA）研究。
与对照干预相比，严格控制导致更大程度的改善，且达到低疾病活动或缓解预设目标的患者百分比更高。在FIN-RACo试验中，分析完成研究的患者亚组，严格控制组68%的患者达到缓解（疾病活动评分28关节（DAS28）<2.6），而对照组为41%[校正后]。在TICORA研究中，基于疾病活动评分（DAS）<1.6，严格控制组65%的患者达到缓解，而对照组为16%（p<0.0001）。在CAMERA研究中，使用计算机决策模型的严格控制组50%的患者达到缓解，而对照组为37%（p = 0.029）。BeSt研究仅由旨在实现DAS<1.6的严格控制组组成；38-46%的患者实现了缓解。这高于早期试验中13-36%的缓解范围。
旨在实现低疾病活动甚至更好的缓解的严格控制，在临床试验中治疗RA患者似乎是一个有前景的选择，在日常实践中可能也是如此。
