Department of Rheumatology, Leiden University Medical Center, Leiden, PO BOX 9600, 2300 RC Leiden, The Netherlands.
Ann Rheum Dis. 2012 Sep;71(9):1472-7. doi: 10.1136/annrheumdis-2011-200736. Epub 2012 Mar 8.
Classifying more patients as rheumatoid arthritis (RA) (2010 American College of Rheumatology/European League Against Rheumatism criteria for RA) may improve treatment outcomes but may cause overtreatment in daily practice. The authors determined the efficacy of initial methotrexate (MTX) plus prednisone treatment in patients with 1987 or 2010 classified RA and undifferentiated arthritis (UA).
610 recent onset RA or UA patients started with MTX 25 mg/week and prednisone 60 mg/day tapered to 7.5 mg/day in 7 weeks. Percentage remissions after 4 months were compared between RA (1987 or 2010 criteria) and UA. Predictors for remission were identified.
With the 2010 criteria, 19% more patients were classified as RA than with the 1987 criteria, but similar remission rates were achieved: 291/479 (61%) 2010 classified RA and 211/264 (58%) 1987 classified RA patients (p=0.52), and 79/122 (65%) UA patients (p=0.46). Anticitrullinated protein antibodies (ACPA) positive RA patients achieved more remission (66%) than ACPA negative RA patients (51%, p=0.001), but also had a lower mean baseline Disease Activity Score (DAS) (3.2 vs 3.6, p<0.001). Independent predictors for remission were male sex, low joint counts, DAS and Health Assessment Questionnaire, low body mass index and ACPA positivity.
Initial treatment with MTX and a tapered high dose of prednisone results in similarly high remission percentages after 4 months (about 60%) in RA patients, regardless of fulfilling the 1987 or 2010 criteria, and in UA patients. Independent predictors indicate that initiating treatment while disease activity is relatively low results in more remission.
将更多患者归类为类风湿关节炎（RA）（2010 年美国风湿病学会/欧洲抗风湿病联盟 RA 标准）可能改善治疗结果，但在日常实践中可能会导致过度治疗。作者确定了在符合 1987 年或 2010 年 RA 和未分化关节炎（UA）分类的患者中，初始甲氨蝶呤（MTX）加泼尼松治疗的疗效。
610 例新发 RA 或 UA 患者开始服用 MTX 25mg/周和泼尼松 60mg/天，7 周内逐渐减至 7.5mg/天。在 4 个月后比较 RA（1987 年或 2010 年标准）和 UA 之间的缓解率。确定缓解的预测因素。
根据 2010 年标准，与 1987 年标准相比，有 19%的患者被归类为 RA，但达到了相似的缓解率：2010 年分类的 RA 患者中有 291/479（61%），1987 年分类的 RA 患者中有 211/264（58%）（p=0.52），UA 患者中有 79/122（65%）（p=0.46）。抗瓜氨酸蛋白抗体（ACPA）阳性 RA 患者的缓解率（66%）高于 ACPA 阴性 RA 患者（51%，p=0.001），但基线疾病活动评分（DAS）平均值也较低（3.2 对 3.6，p<0.001）。缓解的独立预测因素为男性、低关节计数、DAS 和健康评估问卷、低体重指数和 ACPA 阳性。
在 RA 患者和 UA 患者中，初始使用 MTX 和逐渐减少剂量的高剂量泼尼松治疗，在 4 个月后（约 60%）获得的缓解率相似，无论是否符合 1987 年或 2010 年标准。独立预测因素表明，在疾病活动相对较低时开始治疗可获得更多缓解。
