Rheumatology Department, Mohamed Vth University Souissi, El Ayachi Hospital, Salé, Ibn Sina Universitary Hospital, Rabat, Morocco.
Joint Bone Spine. 2012 Jan;79(1):43-6. doi: 10.1016/j.jbspin.2011.02.019. Epub 2011 Apr 15.
This study aimed to evaluate remission in patients with early RA treated by conventional DMARDs and to identify its possible predictor factors.
Patients with early RA (<12 months) were enrolled in a 2-year follow-up study. Standard evaluation completed at baseline and at 24 months included clinical, laboratory, functional and structural assessment. Clinical remission after 2 years of follow-up was defined when DAS28 was less than 2.6. Possible predictor factors for remission were analyzed.
Fifty-one patients (88.2% women, mean age of 46.9 [24-72] years, mean disease duration of 24 [6-48] weeks) were enrolled in this study. The delay in referral for specialist care was 140 [7-420] days. Rheumatoid factor, anti-CCP, HLA-DRB101 and DRB104 alleles were present respectively in 62.5, 56.6, 11.8, and 45.1% of patients. At 24 months, 77.2% received a median dose of 5 (0-8) mg/day of prednisone and 65.2% was taking methotrexate (MTX). 13.6% of patients had stopped their DMARD because of socioeconomic difficulties. At 24 months, we noted a significant improvement of morning stiffness, pain score, swollen joint count, ESR, CRP, DAS28 and HAQ scores. Remission at 2 years was noted in 34.8% of patients and was significantly associated in univariate but not in multivariate analysis to male sex (P=0.02) and to short delay in referral for specialist (P=0.03).
In this cohort of early RA patients treated with conventional DMARDs, especially with methotrexate in monotherapy, remission at 2-year of follow-up was obtained in one third of patients. No predictor factors of remission were found out. These results should be verified by further studies.
本研究旨在评估接受传统 DMARDs 治疗的早期 RA 患者的缓解情况，并确定其可能的预测因素。
纳入了一项为期 2 年的随访研究的早期 RA（<12 个月）患者。基线和 24 个月时完成的标准评估包括临床、实验室、功能和结构评估。在 2 年随访后，当 DAS28 小于 2.6 时，定义为临床缓解。分析了缓解的可能预测因素。
本研究纳入了 51 名患者（88.2%为女性，平均年龄为 46.9[24-72]岁，平均病程为 24[6-48]周）。转诊至专科医生处的延迟时间为 140[7-420]天。类风湿因子、抗 CCP、HLA-DRB101 和 DRB104 等位基因分别存在于 62.5%、56.6%、11.8%和 45.1%的患者中。在 24 个月时，77.2%的患者接受了中位数为 5（0-8）mg/天的泼尼松治疗，65.2%的患者接受了甲氨蝶呤（MTX）治疗。13.6%的患者因社会经济困难而停止使用 DMARD。在 24 个月时，我们注意到晨僵、疼痛评分、肿胀关节计数、ESR、CRP、DAS28 和 HAQ 评分均显著改善。在 2 年时，34.8%的患者达到缓解，在单因素分析中，与缓解显著相关，但在多因素分析中不相关的因素为男性（P=0.02）和专科医生转诊延迟时间短（P=0.03）。
在接受传统 DMARDs 治疗的早期 RA 患者中，特别是接受甲氨蝶呤单药治疗的患者，在 2 年随访时，有三分之一的患者达到缓解。未发现缓解的预测因素。这些结果需要进一步研究验证。
