Castañeda Santos, Navarro Federico, Fernández-Carballido Cristina, Tornero Carmelo, Marced Elena, Corteguera Montserrat
Servicio de Reumatología, Hospital Universitario de la Princesa, Madrid, España.
Reumatol Clin. 2011 May-Jun;7(3):172-8. doi: 10.1016/j.reuma.2010.08.001. Epub 2011 Feb 23.
To assess the differences in the clinical and therapeutic management of early and established rheumatoid arthritis (RA) in clinical practice.
Retrospective and multicentre study including 360 patients diagnosed with RA. During the 12 months prior to the study, onset, sociodemographic, clinical and therapeutic data were collected by clinical chart review.
A total of 152 patients with early RA and 208 with established RA were studied. 97.5% had received disease-modifying anti-rheumatic drugs (DMARDs) and 43.6% a TNFa blocker between the diagnosis and the start of the study. Established RA patients used TNFa blockers more frequently than early RA patients (60,1% vs 21,1%, p<0,001). Methotrexate was the most commonly used drug (70.6%). A treatment change was seen in 79% of patients with early RA and 60.6% of those with established RA. A dose change was the most frequent modification and an inadequate response the most frequent reason. A 25.8% of treatments were stopped due to adverse events. The mean (SD) decrease on DAS28 score was 0.9 (1.5) on early RA and 0.2 (1.0) on established RA patients. A 35.8% of early RA patients showed a good EULAR response, while only 16.2% among established RA patients (p<0.001). Rheumatoid factor and radiological progression assessment were the most requested determinations in early RA (p<0.05).
Spanish rheumatologists used biological drugs with a higher frequency in patients with more advanced disease, as recommended in the main clinical practice guidelines.
评估临床实践中早期和确诊类风湿关节炎（RA）在临床及治疗管理方面的差异。
一项回顾性多中心研究，纳入360例确诊为RA的患者。在研究前12个月期间，通过查阅临床病历收集发病情况、社会人口统计学、临床及治疗数据。
共研究了152例早期RA患者和208例确诊RA患者。在诊断至研究开始期间，97.5%的患者接受了改善病情抗风湿药物（DMARDs）治疗，43.6%的患者使用了肿瘤坏死因子α（TNFα）阻滞剂。确诊RA患者比早期RA患者更频繁地使用TNFα阻滞剂（60.1%对21.1%，p<0.001）。甲氨蝶呤是最常用的药物（70.6%）。79%的早期RA患者和60.6%的确诊RA患者出现了治疗改变。剂量改变是最常见的调整方式，反应不足是最常见的原因。25.8%的治疗因不良事件而停止。早期RA患者的DAS28评分平均（标准差）下降0.9（1.5），确诊RA患者下降0.2（1.0）。35.8%的早期RA患者显示出良好的欧洲抗风湿病联盟（EULAR）反应，而确诊RA患者中只有16.2%（p<0.001）。类风湿因子和放射学进展评估是早期RA中最常要求的检查项目（p<0.05）。
正如主要临床实践指南所推荐的，西班牙风湿病学家在病情更严重的患者中更频繁地使用生物药物。
