Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
J Rheumatol. 2011 Feb;38(2):242-6. doi: 10.3899/jrheum.091446. Epub 2010 Nov 15.
To identify factors associated with radiographic progression at 52 weeks in patients with rheumatoid arthritis (RA) after 12 weeks of methotrexate (MTX) therapy.
The study population consisted of patients from the MTX arm of the Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes (TEMPO). Logistic regression analysis was used to identify clinical and laboratory assessments performed at Week 12 of MTX therapy that might be associated with Week 52 radiographic outcome (modified total Sharp score). Classification and regression tree (CART) modeling of the Week 12 assessments was used to determine the subgroups of patients with the best and worst radiographic outcomes.
A total of 169 patients were analyzed: 116 patients in the best radiographic outcome group and 53 patients in the worst radiographic outcome group. Logistic regression analysis showed that Week 12 C-reactive protein (CRP) level, erythrocyte sedimentation rate, tender joint count, swollen joint count (SJC), and Health Assessment Questionnaire scores were significantly associated with radiographic progression at Week 52 (p < 0.05 for each assessment). CART modeling showed that patients with Week 12 CRP > 0.67 mg/dl and SJC > 1 and patients with Week 12 CRP ≤ 0.67 mg/dl and SJC > 10 were likely to show the worst radiographic progression at Week 52. The CART model had a sensitivity of 85%, specificity of 60%, and overall classification accuracy of 68%.
In patients with RA, measures of CRP and SJC after 12 weeks of MTX therapy emerged as the factors most associated with radiographic progression at Week 52.
在接受甲氨蝶呤（MTX）治疗 12 周后，确定类风湿关节炎（RA）患者在第 52 周时影像学进展的相关因素。
研究人群来自甲氨蝶呤治疗的依那西普和甲氨蝶呤放射学患者结局试验（TEMPO）的 MTX 组。使用逻辑回归分析来确定在 MTX 治疗的第 12 周进行的临床和实验室评估，这些评估可能与第 52 周的放射学结果（改良总 Sharp 评分）相关。对第 12 周的评估进行分类回归树（CART）建模，以确定具有最佳和最差放射学结果的患者亚组。
共分析了 169 例患者：116 例患者的放射学结果最佳，53 例患者的放射学结果最差。逻辑回归分析显示，第 12 周 C 反应蛋白（CRP）水平、红细胞沉降率、压痛关节计数、肿胀关节计数（SJC）和健康评估问卷评分与第 52 周的放射学进展显著相关（每项评估 p < 0.05）。CART 模型显示，第 12 周 CRP > 0.67 mg/dl 和 SJC > 1 的患者以及第 12 周 CRP ≤ 0.67 mg/dl 和 SJC > 10 的患者可能在第 52 周时出现最严重的放射学进展。CART 模型的敏感性为 85%，特异性为 60%，总分类准确性为 68%。
在接受 MTX 治疗 12 周后的 RA 患者中，CRP 和 SJC 的测量值是与第 52 周时放射学进展最相关的因素。
