Verschueren P, Esselens G, Westhovens R
Department of Rheumatology, University Hospitals, Leuven, Belgium.
Scand J Rheumatol. 2009 May-Jun;38(3):166-72. doi: 10.1080/03009740802484846.
To evaluate possible predictors of remission, normalized physical function, and work change in rheumatoid arthritis (RA).
We determined in our early RA cohort the proportion of patients in remission [Disease Activity Score (DAS28)<2.6], with normalized function [Health Assessment Questionnaire (HAQ) = 0], and with changed working situation since disease onset. Candidate predictors of remission, normalized function, and work change were studied by subgroup comparison and logistic regression analysis, including demographics, education, rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibodies, treatment, and DAS28, HAQ, pain and fatigue scores (on the visual analogue scale, VAS).
Median (interquartile range, IQR) disease duration was 18 (29) months. Of 89 patients included, 69% were in remission. DAS28, HAQ, pain and fatigue scores of these patients were lower throughout year 1, although similar at baseline, compared to patients not in remission. At month 4, more of these patients were already good responders. Remission at month 4 independently predicted remission at follow-up. Thirty-eight per cent had no functional limitations; compared to patients with limitations, they had a lower baseline HAQ and lower DAS28, HAQ, pain and fatigue scores during year 1. At month 4, more achieved remission or HAQ = 0. Male sex, baseline HAQ, and month 4 good European League Against Rheumatism (EULAR) response predicted long-term HAQ = 0, but month 4 HAQ = 0 was the strongest independent predictor. Of the 40% with a paid job at baseline, 43.8% reported changes in their work situation; they had higher DAS28, HAQ, pain and fatigue scores during year 1. Failing a month 4 good EULAR response independently predicted work change.
Month 4 disease response predicts later remission, normalized physical function, and work change in RA.
评估类风湿关节炎（RA）缓解、身体功能正常化及工作变化的可能预测因素。
我们在早期RA队列中确定了缓解（疾病活动评分（DAS28）<2.6）、功能正常化（健康评估问卷（HAQ）=0）以及自疾病发作以来工作状况发生变化的患者比例。通过亚组比较和逻辑回归分析研究缓解、功能正常化和工作变化的候选预测因素，包括人口统计学、教育程度、类风湿因子（RF）、抗环瓜氨酸肽（抗CCP）抗体、治疗以及DAS28、HAQ、疼痛和疲劳评分（视觉模拟量表，VAS）。
疾病持续时间的中位数（四分位间距，IQR）为18（29）个月。纳入的89例患者中，69%处于缓解状态。与未缓解的患者相比，这些患者在第1年全年的DAS28、HAQ、疼痛和疲劳评分均较低，尽管基线时相似。在第4个月时，这些患者中更多已为良好应答者。第4个月时的缓解独立预测随访时的缓解。38%的患者无功能限制；与有功能限制的患者相比，他们的基线HAQ较低，且在第1年期间DAS28、HAQ、疼痛和疲劳评分较低。在第4个月时，更多患者实现缓解或HAQ = 0。男性、基线HAQ以及第4个月时良好的欧洲抗风湿病联盟（EULAR）反应预测长期HAQ = 0，但第4个月时HAQ = 0是最强的独立预测因素。在基线时有带薪工作的40%患者中，43.8%报告工作状况发生变化；他们在第1年期间的DAS28、HAQ、疼痛和疲劳评分较高。未达到第4个月时良好的EULAR反应独立预测工作变化。
第4个月时的疾病反应可预测RA后期的缓解、身体功能正常化及工作变化。
