Lapeyronie Hospital, Montpellier I University, Montpellier: UMR 5535, France.
Pfizer, PIO, Paris, France.
Ann Rheum Dis. 2015 Apr;74(4):724-9. doi: 10.1136/annrheumdis-2013-204178. Epub 2014 Jan 7.
To investigate if patients with early RA with persistent moderate disease activity during the first year after diagnosis have a worse 3-5 year outcome than those who achieve sustained clinical remission within the first year, in a daily life setting.
The ESPOIR cohort included patients with early arthritis of <6 months' duration. Treatment was the standard of care. We had 5-year follow-up data for 573 patients. This study compared patients who had persistent moderate disease activity (Disease Activity Score in 28 joints (DAS28)>3.2 and ≤5.1) at both the 6- and 12-month visits, with those who were in sustained DAS28 remission. The primary outcome was radiographic progression at the 36-month visit. Secondary endpoints were clinical remission (DAS28 score, Simplified Disease Activity Index, ACR/EULAR criteria), Health Assessment Questionnaire-Disability Index (HAQ-DI) and number of missed workdays at months 36 and 60. A Fisher exact test was used to compare categorical variables, and the Kruskal-Wallis test for quantitative variables. Logistic regression analysis was used to determine predictors of outcome.
Patients were aged 48.1±12.5 years and their duration of symptoms was 103.2±52.1 days. Mean baseline DAS28 was 5.1±1.3. Persistent moderate disease activity (107 patients) rather than sustained remission (155 patients) during the first year was associated with increased radiographic disease progression at 3 years (OR=1.99 (95% CI 1.01 to 3.79)), increased HAQ-DI at 3 and 5 years (5.23 (2.81 to 9.73) and 4.10 (2.16 to 7.80), respectively), a 7-11 times smaller chance of achieving clinical remission and a five times greater number of missed workdays.
Patients with early RA with persistent moderate disease activity during the first year had a worse outcome than patients who achieved sustained clinical remission. Persistent moderate disease activity affects long-term structure, remission rate and functional and work disability. Such patients may benefit from intensive treatment.
在日常环境中，研究在诊断后第一年持续存在中度疾病活动的早期类风湿关节炎患者与在第一年达到持续临床缓解的患者相比，3-5 年的预后是否更差。
ESPOIR 队列纳入了病程<6 个月的早期关节炎患者。治疗为标准治疗。我们对 573 例患者进行了 5 年随访。本研究比较了在第 6 个月和第 12 个月访视时持续存在中度疾病活动（DAS28>3.2 且≤5.1）的患者与持续达到 DAS28 缓解的患者。主要结局为 36 个月时的放射学进展。次要结局为临床缓解（DAS28 评分、简化疾病活动指数、ACR/EULAR 标准）、健康评估问卷残疾指数（HAQ-DI）和第 36 个月和第 60 个月的错过工作日数。采用 Fisher 确切检验比较分类变量，采用 Kruskal-Wallis 检验比较定量变量。采用逻辑回归分析确定结局的预测因素。
患者年龄为 48.1±12.5 岁，症状持续时间为 103.2±52.1 天。基线 DAS28 平均为 5.1±1.3。在第一年中持续存在中度疾病活动（107 例）而非持续缓解（155 例）与 3 年时放射学疾病进展增加相关（OR=1.99（95%CI 1.01-3.79））、3 年和 5 年时 HAQ-DI 增加（分别为 5.23（2.81-9.73）和 4.10（2.16-7.80））、达到临床缓解的机会小 7-11 倍、错过工作日数多 5 倍。
在第一年持续存在中度疾病活动的早期 RA 患者预后比达到持续临床缓解的患者更差。持续的中度疾病活动会影响长期结构、缓解率和功能以及工作障碍。此类患者可能受益于强化治疗。
