Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510, 20th St. South, FOT 805D, Birmingham, AL 35294.
Semin Arthritis Rheum. 2013 Oct;43(2):137-43. doi: 10.1016/j.semarthrit.2013.02.002. Epub 2013 Jun 3.
To determine the prevalence and persistence of new-onset clinical remission in rheumatoid arthritis (RA) patients.
The Consortium of Rheumatology Researchers of North America (CORRONA) cohort was used to examine the prevalence of remission and associated comorbidities and RA therapies according to the 2011 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) remission criteria. Factors influencing the likelihood of remaining in remission were identified by logistic regression with generalized estimating equations. Analysis of variance and Tukey's test were used to determine differences in disability according to whether RA patients had been in remission or only low disease activity (LDA).
A total of 2105 individuals met ACR/EULAR remission criteria at the most recent visit within CORRONA, yielding an 8% point prevalence of remission. Patients with certain comorbidities (e.g., heart failure) were significantly less likely to achieve or remain in remission compared to those without these conditions (p < 0.001 for each). Among prednisone users, the prevalence of remission was 1-6% (depending on dose) higher compared to those not on prednisone (10%). More than 50% of patients who had consistently been in remission for ≥1 year were able to remain in remission over the next year. Patients consistently in remission had less disability than patients who achieved LDA or who fluctuated between remission and LDA.
Patients consistently in remission for at least 1 year had a high likelihood to remain in remission. These individuals might be considered the most likely candidates for de-escalation or withdrawal of RA treatments.
确定类风湿关节炎（RA）患者新发临床缓解的患病率和持续性。
利用北美风湿病研究联合会（CORRONA）队列研究，根据 2011 年美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）缓解标准，检查缓解的患病率以及与缓解相关的合并症和 RA 治疗情况。使用广义估计方程的逻辑回归来确定影响持续缓解可能性的因素。采用方差分析和 Tukey 检验，根据 RA 患者是否处于缓解期或仅处于低疾病活动度（LDA）来确定残疾差异。
CORRONA 中共有 2105 人在最近一次就诊时符合 ACR/EULAR 缓解标准，缓解率为 8%。与无这些合并症的患者相比，患有某些合并症（如心力衰竭）的患者达到或持续缓解的可能性显著降低（每种情况均<0.001）。在使用泼尼松的患者中，与未使用泼尼松的患者相比，缓解率高 1-6%（取决于剂量）（10%）。超过 50%的持续缓解≥1 年的患者能够在接下来的一年中保持缓解。持续缓解的患者比达到 LDA 的患者或缓解和 LDA 之间波动的患者的残疾程度更低。
持续缓解至少 1 年的患者有很大可能持续缓解。这些患者可能是降级或停止 RA 治疗的最可能候选者。
