Division of Rheumatology/Section of Clinical Sciences, Alumnae Hall - Room 305, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Ann Rheum Dis. 2012 May;71(5):681-6. doi: 10.1136/ard.2011.154625. Epub 2011 Oct 12.
One goal of remission in rheumatoid arthritis (RA) is to halt joint damage. The authors assessed the progression of radiographic joint damage among RA patients in remission by the new ACR/EULAR criteria (Boolean approach) compared with remission thresholds for the simplified disease activity index (SDAI), clinical disease activity index (CDAI) and disease activity score based on 28 joints and C-reactive protein (DAS28-CRP) in an observational cohort, and evaluated the relationship between time in remission and radiographic joint damage.
535 RA patients underwent physical examination and laboratory assessment at baseline, 1 and 2 years. Radiographs at baseline and 2 years were scored by the van der Heijde modified Sharp score (TSS). Positive likelihood ratios for a good radiographic outcome (change in TSS <1 unit/year) were calculated for each of the remission criteria. Radiographic progression was compared between patients in remission at none, one, two and three visits by χ(2) goodness of fit statistics.
20% of patients in ACR/EULAR remission at baseline had radiographic progression, 24% in SDAI remission, 19% in CDAI remission and 30% of patients in DAS28-CRP remission. The positive likelihood ratio for good radiographic outcome was 2.6 for ACR/EULAR criteria, 2.1 for SDAI, 2.8 for CDAI and.1.5 for DAS28-CRP. Reduced radiographic progression was observed for patients with an increasing number of visits in remission (p<0.003 for all criteria, χ(2) goodness of fit statistics).
Patients with RA in remission by any established criteria can experience radiographic progression. An increased number of visits in remission was associated with reduced radiographic damage.
类风湿关节炎（RA）缓解的目标之一是停止关节损伤。作者通过新的 ACR/EULAR 标准（布尔方法）评估了 RA 缓解患者的放射学关节损伤进展，与简化疾病活动指数（SDAI）、临床疾病活动指数（CDAI）和基于 28 个关节和 C 反应蛋白的疾病活动评分（DAS28-CRP）的缓解阈值进行了比较，并评估了缓解时间与放射学关节损伤之间的关系。
535 例 RA 患者在基线、1 年和 2 年时进行体格检查和实验室评估。基线和 2 年时的 X 线片由 van der Heijde 修改后的 Sharp 评分（TSS）进行评分。为每个缓解标准计算了良好放射学结果（TSS 变化<1 个单位/年）的阳性似然比。通过 χ²拟合优度检验比较了在无、一次、两次和三次就诊时处于缓解状态的患者之间的放射学进展。
基线时处于 ACR/EULAR 缓解的 20%患者出现放射学进展，SDAI 缓解的 24%，CDAI 缓解的 19%，DAS28-CRP 缓解的 30%。良好放射学结果的阳性似然比为 ACR/EULAR 标准为 2.6，SDAI 为 2.1，CDAI 为 2.8，DAS28-CRP 为 1.5。随着缓解就诊次数的增加，观察到放射学进展减少（所有标准均<0.003，χ²拟合优度检验）。
符合任何既定标准缓解的 RA 患者可出现放射学进展。缓解就诊次数的增加与放射学损伤减少相关。
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