Haddad Amir, Thavaneswaran Arane, Ruiz-Arruza Ioana, Pellett Fawnda, Chandran Vinod, Cook Richard J, Gladman Dafna D
University of Toronto Psoriatic Arthritis Program and Toronto Western Hospital, Toronto, Ontario, Canada.
University of Toronto Psoriatic Arthritis Program and Toronto Western Research Institute, Toronto, Ontario, Canada.
Arthritis Care Res (Hoboken). 2015 May;67(6):842-7. doi: 10.1002/acr.22529.
A state of minimal disease activity (MDA) was defined and validated as target for treatment in psoriatic arthritis (PsA). We aimed to identify disease characteristics, outcome, and predictors of MDA in patients treated with tumor necrosis factor α (TNFα) blockers.
Patients fulfilling the Classification of Psoriatic Arthritis criteria treated with TNFα blockers were followed every 3-6 months. Patients were considered in MDA when they meet at least 5 of the 7 criteria. Sustained MDA was defined as an MDA state lasting ≥12 months. Patients achieving MDA were compared to non-MDA patients. A proportional odds discrete time survival analysis model was applied, adjusting for sex, age, PsA duration, abnormal erythrocyte sedimentation rate (ESR) and clinically damaged joint count at each visit to identify predictors for MDA.
Of the 306 patients treated with TNFα blockers identified from our database, 23 patients were in an MDA state when treatment was commenced; 57 were taking TNFα blockers prior to enrollment. Therefore, 226 subjects were in a non-MDA state and constituted the study population. One hundred forty-five patients of 226 patients (64%) achieved MDA within a mean ± SD duration of 1.30 ± 1.68 years. The mean ± SD duration of MDA was 3.46 ± 2.25 years. At total of 17 patients withdrew from therapy and remained in an MDA state. Male sex (odds ratio [OR] 1.65, 95% confidence interval [95% CI] 1.08-2.53; P = 0.02) and normal ESR (OR 2.27, 95% CI 1.22-4.17; P = 0.009) increased the odds for achieving MDA.
MDA is achieved in 64% of patients treated with TNFα blockers in a clinical setting. Male sex and normal ESR are predictors for MDA. On withdrawal or reduction in treatment, 11.6% of patients maintained MDA state.
定义并验证最小疾病活动度（MDA）状态作为银屑病关节炎（PsA）的治疗目标。我们旨在确定接受肿瘤坏死因子α（TNFα）阻滞剂治疗的患者的疾病特征、结局及MDA的预测因素。
符合银屑病关节炎分类标准且接受TNFα阻滞剂治疗的患者每3至6个月随访一次。当患者满足7项标准中的至少5项时，被视为处于MDA状态。持续MDA定义为持续≥12个月的MDA状态。将达到MDA的患者与未达到MDA的患者进行比较。应用比例优势离散时间生存分析模型，对每次就诊时的性别、年龄、PsA病程、红细胞沉降率（ESR）异常及临床受损关节计数进行校正，以确定MDA的预测因素。
从我们的数据库中确定的306例接受TNFα阻滞剂治疗的患者中，23例在开始治疗时处于MDA状态；57例在入组前正在服用TNFα阻滞剂。因此，226例受试者处于非MDA状态并构成研究人群。226例患者中的145例（64%）在平均±标准差为1.30±1.68年的时间内达到MDA。MDA的平均±标准差持续时间为3.46±2.25年。共有17例患者退出治疗并维持在MDA状态。男性（优势比[OR]1.65，95%置信区间[95%CI]1.08 - 2.53；P = 0.02）和ESR正常（OR 2.27，95%CI 1.22 - 4.17；P = 0.009）增加了达到MDA的几率。
在临床环境中，64%接受TNFα阻滞剂治疗的患者达到MDA。男性和ESR正常是MDA的预测因素。在停药或减少治疗时，11.6%的患者维持MDA状态。
