Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
J Rheumatol. 2012 Nov;39(11):2071-80. doi: 10.3899/jrheum.120029. Epub 2012 Aug 15.
Our objective was to describe characteristics of Canadian patients with early arthritis and examine differences between those fulfilling 1987 and 2010 rheumatoid arthritis (RA) classification criteria.
The Canadian Early Arthritis Cohort (CATCH) is a national, multicenter, observational, prospective cohort of patients with early inflammatory arthritis, receiving usual care, recruited since 2007. Inclusion criteria include age > 16 years; symptom duration 6-52 weeks; swelling of ≥ 2 joints or ≥ 1 metacarpophalangeal/proximal interphalangeal joint; and 1 of rheumatoid factor ≥ 20 IU, positive anticitrullinated protein antibodies (ACPA), morning stiffness ≥ 45 min, response to nonsteroidal antiinflammatory drug, or positive metatarsophalangeal joint squeeze test. Data from patients enrolled to March 15, 2011, were analyzed.
In total, 1450 patients met the eligibility criteria (1187 were followed). At baseline, mean age was 53 ± 15 years, symptom duration was 6.1 ± 3.2 months, Disease Activity Score (DAS28) was 4.9 ± 1.6, Health Assessment Questionnaire-Disability Index was 1.0 ± 0.7. Forty-one percent (n = 450) of patients had moderate (3.2 < DAS28 ≤ 5.1) and 46% (n = 505) had high (DAS28 > 5.1) disease activity; 28% of those with baseline radiographs (n = 250/908) had radiographic evidence of erosions. ACPA status was available for 70% (n = 831) of patients; 55% (n = 453) tested positive. Sixty percent (n = 718) of patients were treated with methotrexate (MTX) initially. Of 612 patients without erosions, 63% and 83% fulfilled 1987 and 2010 RA classification criteria, respectively. Seventy-three percent (n = 166) of those who did not fulfill 1987 criteria were newly identified by the 2010 criteria. These patients had less severe disease and more were MTX-naive compared to those satisfying the 1987 criteria. Forty-seven percent of all patients achieved remission at 1 year.
Patients with early RA present with moderate high disease activity; < 50% achieve remission at 1 year, despite MTX treatment in the majority. The 2010 RA classification criteria identify more patients with RA who would previously have been designated as having undifferentiated disease. However, these patients have lower disease activity at the time of identification.
本研究旨在描述加拿大早期关节炎患者的特征，并比较符合 1987 年和 2010 年类风湿关节炎（RA）分类标准的患者之间的差异。
加拿大早期关节炎队列研究（CATCH）是一项全国性、多中心、观察性、前瞻性队列研究，纳入了自 2007 年以来接受常规治疗的早期炎症性关节炎患者。纳入标准包括年龄＞16 岁；症状持续时间 6-52 周；≥2 个关节肿胀或≥1 个掌指关节/近端指间关节肿胀；类风湿因子≥20IU，抗瓜氨酸化蛋白抗体阳性，晨僵≥45min，对非甾体抗炎药有反应，或阳性跖趾关节挤压试验。分析了 2011 年 3 月 15 日前入组的患者的数据。
共有 1450 名患者符合入选标准（1187 名患者被随访）。基线时，患者平均年龄为 53±15 岁，症状持续时间为 6.1±3.2 个月，疾病活动评分（DAS28）为 4.9±1.6，健康评估问卷残疾指数为 1.0±0.7。41%（n=450）的患者有中度（3.2＜DAS28≤5.1）和 46%（n=505）有高度（DAS28＞5.1）疾病活动；28%基线时拍摄了 X 光片的患者（n=250/908）有侵蚀性放射学证据。70%（n=831）的患者有 ACPA 状态；55%（n=453）检测结果为阳性。60%（n=718）的患者最初接受甲氨蝶呤（MTX）治疗。在 612 名没有侵蚀性病变的患者中，分别有 63%（n=391）和 83%（n=511）符合 1987 年和 2010 年 RA 分类标准。在不符合 1987 年标准的 166 名患者中，有 73%（n=120）是通过 2010 年标准新诊断的。这些患者的疾病严重程度较轻，且与符合 1987 年标准的患者相比，MTX 初治患者更多。所有患者中有 47%在 1 年内达到缓解。
患有早期 RA 的患者表现出中高度的疾病活动度；尽管大多数患者接受了 MTX 治疗，但＜50%的患者在 1 年内达到缓解。2010 年 RA 分类标准确定了更多的 RA 患者，这些患者之前可能被归类为未分化疾病。然而，这些患者在确诊时的疾病活动度较低。
