地塞米松对关节痛患者自身抗体水平和关节炎发展的影响：一项随机试验。
Effect of dexamethasone on autoantibody levels and arthritis development in patients with arthralgia: a randomised trial.
机构信息
Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands.
出版信息
Ann Rheum Dis. 2010 Mar;69(3):571-4. doi: 10.1136/ard.2008.105767. Epub 2009 Apr 9.
BACKGROUND
Rheumatoid arthritis is characterised by antibodies to citrullinated proteins (ACPA) and rheumatoid factor (RF) in the preclinical phase.
OBJECTIVE
To determine whether an intervention aimed at decreasing autoantibody levels in people at risk may be effective in preventing progression to arthritis.
METHODS
83 patients with arthralgia positive for ACPA or IgM-RF were randomly allocated to intramuscular injections of 100 mg dexamethasone or placebo at baseline and 6 weeks. The primary end point was a 50% antibody reduction or normalisation at 6 months.
RESULTS
The primary end point was reached in one patient in each group. Patients treated with dexamethasone had reductions of antibody levels after 1 month (ACPA 222% and IgM-RF 214%), which persisted at 6 months for ACPA. During a median follow-up of 26 months, arthritis development in both groups was similar (20% vs 21%).
CONCLUSION
In autoantibody-positive patients with arthralgia, dexamethasone treatment decreases ACPA and IgM-RF levels, but does not prevent arthritis development.
TRIAL REGISTRATION NUMBER
ISRCTN73232918.
背景
类风湿关节炎的特征是在临床前阶段存在针对瓜氨酸化蛋白（ACPA）和类风湿因子（RF）的抗体。
目的
确定针对有风险人群降低自身抗体水平的干预措施是否可能有效预防关节炎进展。
方法
83 例 ACPA 或 IgM-RF 阳性的关节痛患者被随机分配在基线和 6 周时接受肌肉注射 100mg 地塞米松或安慰剂。主要终点是在 6 个月时抗体减少 50%或正常化。
结果
两组各有 1 例患者达到主要终点。地塞米松治疗组在 1 个月后抗体水平降低（ACPA 降低 222%，IgM-RF 降低 214%），在 6 个月时 ACPA 仍持续降低。在中位随访 26 个月期间，两组关节炎的发展情况相似（20%对 21%）。
结论
在有关节痛且 ACPA 阳性的患者中，地塞米松治疗可降低 ACPA 和 IgM-RF 水平，但不能预防关节炎的发生。
试验注册号
ISRCTN73232918。
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