Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, F02.127, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Ann Rheum Dis. 2011 Jun;70(6):1099-103. doi: 10.1136/ard.2010.137943. Epub 2011 Mar 15.
To investigate the long-term effects of the tight control (TC) and conventional (CT) methotrexate-based strategies of the Computer Assisted Management in Early Rheumatoid Arthritis trial in early rheumatoid arthritis and evaluate the predictive value of an early response to treatment.
Clinical and radiographic 5-year outcome was compared between initial strategies. Patients were classified according to the EULAR response criteria. The prognostic value of early response to treatment in addition to established predictors was analysed by multiple linear regression analyses.
5 years of data were available for 205 of 299 patients, with no indication for selective drop-out. At 5 years there was no longer any significant difference for clinical and radiographic outcomes between treatment strategies applied during the first 2 years. Good-responders had a mean disease activity score of 2.39 (1.2) and median yearly radiographic progression rate of 0.6 (0.0 to 2.2) at 5 years; significantly lower (both p<0.02) when compared to moderate- and non-responders. Multiple regression analysis showed that early response to treatment is an independent predictor of 5-year outcome, irrespective of treatment strategy.
The difference in disease activity between treatment strategies disappeared over the years. Good-response to treatment independently predicts significantly better 5-year clinical and radiographic outcome. The TC principle probably should be continued in the long-term.
探讨早期类风湿关节炎计算机辅助管理试验中基于甲氨蝶呤的严格控制（TC）和常规（CT）策略的长期效果，并评估早期治疗反应的预测价值。
比较初始策略的临床和放射学 5 年结局。根据 EULAR 反应标准对患者进行分类。通过多元线性回归分析，分析治疗早期反应以及既定预测因素之外的预后价值。
299 例患者中有 205 例可获得 5 年的数据，没有选择性退出的迹象。在 5 年时，前 2 年应用的治疗策略之间的临床和放射学结局不再有显著差异。良好反应者的疾病活动评分平均值为 2.39（1.2），中位数每年放射学进展率为 0.6（0.0 至 2.2）；与中反应和无反应者相比，显著降低（均 p<0.02）。多元回归分析表明，早期治疗反应是 5 年结局的独立预测因素，与治疗策略无关。
治疗策略之间的疾病活动差异随着时间的推移而消失。治疗反应良好独立预测显著更好的 5 年临床和放射学结局。TC 原则可能应在长期内继续。
