Sir Alfred Baring Garrod Clinical Trials Unit, Academic Department of Rheumatology, King's College London, London, UK.
Rheumatology (Oxford). 2010 Jul;49(7):1267-71. doi: 10.1093/rheumatology/kep389. Epub 2009 Dec 11.
To examine if prognostic factors predict the choice of first DMARD for patients with RA.
Details of 616 patients with early RA were collected from 16 centres in the UK Early Rheumatoid Arthritis Network (ERAN). Logistic regression was used to identify whether HAQ score, swollen joint count (SJC), nodules, RF, ESR, CRP and erosions on radiographs were associated with the choice of first DMARD treatment.
Of 616 patients, 547 (88%) were started on a DMARD, 253 (46%) on MTX, 230 (42%) on SSZ, 47 (9%) on other DMARD monotherapies and 17 (3%) on combination DMARD therapy (CoT). SSZ was started less frequently in patients with positive RF (P = 0.018; OR 0.59; 95% CI 0.38, 0.91) and high SJC (P = 0.02; OR 0.95; 95% CI 0.91, 0.99). MTX was favoured in patients with high SJC (P = 0.002; OR 1.07; 95% CI 1.02, 1.11). Non-prescription of DMARDs was associated with old age (P = 0.02; OR 0.98; 95% CI 0.96, 0.99) and low HAQ score (P = 0.009; OR 0.80; 95% CI 0.68, 0.95). None of the variables predicted CoT. All other variables and the hospital where the patient was treated were not independently associated with the choice of DMARD.
When choosing DMARD monotherapy in early RA, rheumatologists in ERAN seem to preferentially prescribe MTX for patients with a poor prognosis and SSZ for patients with good prognosis. No DMARDs were used in older patients or in those with a low HAQ.
探讨预后因素是否能预测类风湿关节炎（RA）患者首选的 DMARD 治疗方案。
从英国早期类风湿关节炎网络（ERAN）的 16 个中心收集了 616 例早期 RA 患者的详细资料。采用逻辑回归分析确定 HAQ 评分、肿胀关节数（SJC）、结节、RF、ESR、CRP 和 X 线片上的侵蚀是否与首选 DMARD 治疗方案相关。
616 例患者中，547 例（88%）接受 DMARD 治疗，253 例（46%）接受 MTX 治疗，230 例（42%）接受 SSZ 治疗，47 例（9%）接受其他 DMARD 单药治疗，17 例（3%）接受联合 DMARD 治疗（CoT）。RF 阳性（P = 0.018；OR 0.59；95%CI 0.38，0.91）和 SJC 较高（P = 0.02；OR 0.95；95%CI 0.91，0.99）的患者较少使用 SSZ。MTX 更常用于 SJC 较高的患者（P = 0.002；OR 1.07；95%CI 1.02，1.11）。未开具 DMARD 与年龄较大（P = 0.02；OR 0.98；95%CI 0.96，0.99）和 HAQ 评分较低（P = 0.009；OR 0.80；95%CI 0.68，0.95）有关。其他变量和患者就诊的医院均不能独立预测 CoT。
在选择早期 RA 的 DMARD 单药治疗时，ERAN 的风湿病医生似乎更倾向于为预后不良的患者开具 MTX，为预后良好的患者开具 SSZ。年龄较大或 HAQ 评分较低的患者不使用 DMARD。
