抗环瓜氨酸肽抗体阳性与阴性的炎症性多关节炎患者早期治疗的获益。
Benefit of early treatment in inflammatory polyarthritis patients with anti-cyclic citrullinated peptide antibodies versus those without antibodies.
机构信息
Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK.
出版信息
Arthritis Care Res (Hoboken). 2010 May;62(5):664-75. doi: 10.1002/acr.20207.
OBJECTIVE
To compare the clinical utility of anti-cyclic citrullinated peptide (anti-CCP) antibodies and rheumatoid factor (RF) testing in predicting both functional outcome and response to treatment in early inflammatory polyarthritis (IP) patients.
METHODS
A total of 916 IP subjects from a primary care incidence registry (1990-1994) had anti-CCP antibody and RF status determined at baseline. Mean change in Health Assessment Questionnaire (HAQ) score between baseline and 5 years was compared by antibody status. The effect of treatment with disease-modifying antirheumatic drugs and/or steroids over 5 years, early (<6 months of symptom onset) versus late initiation, and duration of treatment were also compared by anti-CCP antibody status. The analysis was adjusted for treatment decisions and censoring over the followup, using marginal structural models.
RESULTS
Anti-CCP antibody-positive patients (n = 268) had more severe disease both at presentation and 5 years of followup, and this was independent of RF. On adjustment, anti-CCP antibody-negative patients treated early experienced a significant improvement in functional disability compared with anti-CCP antibody-negative patients who were never treated (-0.31; 95% confidence interval [95% CI] -0.53, -0.08), and experienced additional benefit for each additional month of early treatment. Anti-CCP antibody-positive patients treated early did not have a significant improvement in HAQ score compared with those not treated (-0.14; 95% CI -0.52, 0.24).
CONCLUSION
In this first observational study to examine the influence of anti-CCP antibody status on treatment response, anti-CCP antibody-positive IP patients showed less benefit from treatment, particularly early treatment, than anti-CCP antibody-negative patients. This provides support for the inclusion of anti-CCP antibodies as well as RF in the classification criteria for rheumatoid arthritis and for stratification by anti-CCP antibody status in clinical trials.
目的
比较抗环瓜氨酸肽（anti-CCP）抗体和类风湿因子（RF）检测在预测早期炎症性关节炎（IP）患者的功能结局和治疗反应方面的临床应用。
方法
共有 916 名来自初级保健发病登记处（1990-1994 年）的 IP 患者，在基线时确定了抗 CCP 抗体和 RF 状态。通过抗体状态比较基线和 5 年时健康评估问卷（HAQ）评分的平均变化。还通过抗 CCP 抗体状态比较了 5 年内使用疾病修饰抗风湿药物和/或类固醇治疗、早期（症状发病<6 个月）与晚期开始、以及治疗持续时间的效果。使用边缘结构模型，对随访期间的治疗决策和截尾进行调整，进行分析。
结果
抗 CCP 抗体阳性患者（n = 268）在就诊时和 5 年随访时疾病更严重，且独立于 RF。经调整，与从未治疗的抗 CCP 抗体阴性患者相比，早期治疗的抗 CCP 抗体阴性患者在功能障碍方面有显著改善（-0.31；95%置信区间 [95%CI] -0.53，-0.08），且每提前一个月治疗可获得额外的获益。与未治疗的患者相比，早期治疗的抗 CCP 抗体阳性患者的 HAQ 评分没有显著改善（-0.14；95%CI -0.52，0.24）。
结论
在这项首次观察性研究中，我们研究了抗 CCP 抗体状态对治疗反应的影响，结果显示，与抗 CCP 抗体阴性患者相比，抗 CCP 抗体阳性的 IP 患者从治疗中获益较少，尤其是早期治疗。这为将抗 CCP 抗体与 RF 纳入类风湿关节炎分类标准，并根据抗 CCP 抗体状态进行临床试验分层提供了支持。
Zotero 插件