VU University Medical Centre, Department of Rheumatology, ZH-3A-56, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Ann Rheum Dis. 2012 Jan;71(1):33-7. doi: 10.1136/ard.2011.153742. Epub 2011 Sep 27.
Introduction The new American College for Rheumatology (ACR)/European League Against Rheumatism (EULAR) remission criteria are based on the assessment of 28 joints. A study was undertaken to study the consequences of remission misclassification due to residual disease activity in the feet on physical function and joint damage in the subsequent year in an observational early disease cohort.
All patients with rheumatoid arthritis at inclusion or at 1-year follow-up in the early arthritis cohort of the Jan van Breemen Institute, The Netherlands were included. ACR/EULAR remission definitions for trials and clinical practice were calculated twice, once using a 28-joint count and once using a 38-joint count that included the 10 metatarsophalangeal joints. Disease stability was defined as stable x-ray scores over 1 year (change ≤ 0 in Sharp/van der Heijde scores) and stable and low scores on the Health Assessment Questionnaire (HAQ change ≤ 0 and HAQ score consistently ≤ 0.5), all during the second year after inclusion. Analyses comprised residual disease activity (swollen or tender joints >0) in the feet of patients who fulfilled the candidate remission criteria using a 28-joint count and likelihood ratios of remission definitions to predict disease stability.
Of 421 patients, 9-15% reached remission at 1 year using a 28-joint count. Of these, 26-40% showed activity in the feet. Misclassification due to reduced joint counts was observed in 2-3%. A state of remission increased the likelihood of stability of both x-ray and HAQ, with similar likelihood ratios for definitions using 38-joint counts and those using 28-joint counts.
The ability of remission definitions with 28-joint counts versus 38-joint counts to predict long-term good radiological and functional outcome is similar. This confirms that inclusion of ankles and forefeet in the assessment of remission is not required, although inclusion of these joints in the examination is recommended.
介绍 新的美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）缓解标准基于 28 个关节的评估。本研究旨在研究由于脚部残留疾病活动导致缓解分类错误对后续 1 年内患者身体功能和关节损伤的影响，该研究纳入了观察性早期疾病队列。
所有荷兰 Jan van Breemen 研究所早期关节炎队列中纳入时或 1 年随访时的类风湿关节炎患者均被纳入本研究。使用 28 关节计数和包括 10 个跖趾关节的 38 关节计数，计算了用于临床试验和临床实践的 ACR/EULAR 缓解定义。1 年内 X 射线评分稳定（Sharp/van der Heijde 评分变化≤0），健康评估问卷（HAQ）评分稳定且较低（变化≤0 和 HAQ 评分始终≤0.5）定义为疾病稳定，所有这些均在纳入后第 2 年进行。分析包括满足候选缓解标准的患者中，使用 28 关节计数时脚部的残留疾病活动（肿胀或压痛关节>0）和缓解定义预测疾病稳定的似然比。
421 例患者中，使用 28 关节计数时，1 年缓解率为 9-15%。其中，26-40%的患者脚部有活动。由于关节计数减少导致的分类错误占 2-3%。缓解状态增加了 X 射线和 HAQ 稳定的可能性，使用 38 关节计数和 28 关节计数的定义具有相似的似然比。
使用 28 关节计数与 38 关节计数的缓解定义预测长期良好的影像学和功能结局的能力相似。这证实了在评估缓解时不需要包括踝关节和前足，尽管建议在检查中包括这些关节。
