Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, ON, Canada.
Rheumatology (Oxford). 2010 Jul;49(7):1361-6. doi: 10.1093/rheumatology/keq091. Epub 2010 Apr 12.
To determine predictors and time to response to treatment with TNF-alpha blockers in patients with PsA in a longitudinal observational cohort.
We performed a cohort analysis of patients who were followed prospectively in a large PsA clinic. Response to treatment was defined as an improvement of at least 40% in active (tender and/or swollen) and swollen joint count (SJC) and 50% improvement in the Psoriasis Area and Severity Index (PASI) score.
Ninety-five patients were included in the analysis. Of the total patients, 72.6 and 77.9% demonstrated 40% improvement in active joint counts at 3 and 12 months, respectively. Also, 80.5 and 87.4% of the patients showed 40% improvement in SJC at 3 and 12 months, respectively. A PASI50 was achieved by 54 and 60.4% after 3 and 12 months of treatment, respectively. Of 17 patients who did not achieve 40% improvement in total SJC at 3 months, 11 (64.7%) responded at 12 months. In multivariate analysis, the number of swollen joints at baseline predicted response of total active joints at 12 months [odds ratio (OR) 1.34; P = 0.02], whereas past use of TNF-alpha blocker decreased odds of response (OR 0.05; P = 0.01).
TNF-alpha blockers are effective in most PsA patients with the majority responding within 3 months of treatment. A significant proportion of the early non-responders will have a delayed response to treatment. Higher SJC at baseline and no prior use of TNF-alpha blockers predict response.
在一项纵向观察性队列研究中,确定接受 TNF-α 阻滞剂治疗的银屑病关节炎(PsA)患者的预测因素和治疗反应时间。
我们对在大型 PsA 诊所接受前瞻性随访的患者进行了队列分析。将治疗反应定义为活跃(压痛和/或肿胀)关节计数和肿胀关节计数(SJC)至少改善 40%,以及银屑病面积和严重程度指数(PASI)评分改善 50%。
共有 95 例患者纳入分析。在所有患者中,分别有 72.6%和 77.9%在 3 个月和 12 个月时达到活跃关节计数改善 40%,分别有 80.5%和 87.4%在 3 个月和 12 个月时达到 SJC 改善 40%。分别有 54%和 60.4%的患者在治疗 3 个月和 12 个月后达到 PASI50。在 3 个月时未达到 SJC 总改善 40%的 17 例患者中,有 11 例(64.7%)在 12 个月时应答。多变量分析显示,基线时肿胀关节数预测 12 个月时总活跃关节的反应[优势比(OR)1.34;P=0.02],而既往使用 TNF-α 阻滞剂降低了反应的可能性(OR 0.05;P=0.01)。
TNF-α 阻滞剂对大多数 PsA 患者有效,大多数患者在治疗 3 个月内即可获得缓解。相当一部分早期无应答者将延迟对治疗的反应。基线时 SJC 较高和未使用过 TNF-α 阻滞剂预测反应。