Department of Medicine 3, Division of Rheumatology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Ann Rheum Dis. 2011 Nov;70(11):1975-80. doi: 10.1136/ard.2011.153734. Epub 2011 Jul 28.
Disease activity in rheumatoid arthritis (RA) can be measured clinically (eg, swollen joint count (SJC)) or systemically (eg, C reactive protein (CRP)). In general, both contribute to the progression of joint damage, but the relevance of residual inflammation in patients near remission is unclear.
To determine the independent contribution of SJC and CRP to progression of joint damage in patients near remission.
Data from methotrexate monotherapy arms of the ASPIRE, ERA, Leflunomide, PREMIER and TEMPO trials (n=1184) were pooled and the average SJC and CRP values from visits at 6, 9 and 12 months were determined. The two variables were then dichotomised into active and inactive, where inactive was defined as a mean. Radiographic outcomes were assessed according to these definitions.
The greatest progression was seen in patients in whom both SJC and CRP were active and the smallest in those in whom both were inactive. If SJC was inactive, radiographic progression was not different between those with inactive or active CRP (0.7 ± 4.3/year and 0.8 ± 5.4/year, respectively, p=0.19). However, if CRP was inactive (<1 mg/dl), SJC status still determined radiographic progression (0.7 ± 4.3/year and 1.8 ± 5.6/year, for inactive and active SJC, respectively, p=0.004). The importance of SJC in patients with inactive CRP was also shown in a linear model (p=0.019), while CRP was not significantly different in patients with inactive SJC (p=0.40).
In patients with RA who are near remission, the amount of joint swelling appears to be more predictive of radiographic progression than the amount of CRP.
类风湿关节炎（RA）的疾病活动度可以通过临床（例如，肿胀关节计数（SJC））或系统（例如，C 反应蛋白（CRP））进行测量。通常，这两者都有助于关节损伤的进展，但缓解期临近的患者中残留炎症的相关性尚不清楚。
确定 SJC 和 CRP 对缓解期临近的患者关节损伤进展的独立贡献。
汇总了甲氨蝶呤单药治疗臂的 ASPIRE、ERA、来氟米特、PREMIER 和 TEMPO 试验的数据（n=1184），并确定了 6、9 和 12 个月就诊时的平均 SJC 和 CRP 值。然后将这两个变量分为活跃和不活跃，其中不活跃定义为平均值。根据这些定义评估放射学结果。
SJC 和 CRP 均活跃的患者中进展最大，两者均不活跃的患者中进展最小。如果 SJC 不活跃，CRP 不活跃或活跃的患者之间的放射学进展无差异（分别为 0.7 ± 4.3/年和 0.8 ± 5.4/年，p=0.19）。然而，如果 CRP 不活跃（<1 mg/dl），SJC 状态仍决定放射学进展（分别为 0.7 ± 4.3/年和 1.8 ± 5.6/年，SJC 不活跃和活跃，p=0.004）。在 CRP 不活跃的患者中，SJC 的重要性也在线性模型中得到了体现（p=0.019），而 CRP 在 SJC 不活跃的患者中差异无统计学意义（p=0.40）。
在接近缓解的 RA 患者中，关节肿胀量似乎比 CRP 更能预测放射学进展。
