Malysheva Olga, Bedrich Anne, Kuipers J G, Kleine Henning, Wolff Björn, Baerwald Christoph G
University Hospital Leipzig, Department for Gastroenterology and Rheumatology, Rheumatology Unit, Leipzig, Germany.
Rotes Kreuz Hospital Bremen, Department for Internal Rheumatology, Bremen, Germany.
Clin Exp Rheumatol. 2015 Mar-Apr;33(2):255-8. Epub 2015 Apr 9.
This study focuses on the application and impact of different clinical scores for treatment changes in daily practice in patients with rheumatoid arthritis (RA), as achieving remission is a feasible aim due to considerable improvements in therapeutic options.
In this prospective study, 1467 RA patients aged 15 to 88 years (72.5% female, 27.5% male) who had undergone treatment change or were treated with a disease-modifying antirheumatic drug (DMARD) for the first time were analysed. At three consecutive visits (T-1, T0, T1), scores were used to assess disease activity, loss of function, quality of life and imaging. In addition, the impact of the scores on treatment change was addressed (numerical rating scale, 1-10).
The most commonly used scores were the DAS28 (65% of all visits), the Hanover functional ability questionnaire (FFbH, 36%) and the HAQ (11%). Other scores for evaluating RA are of little relevance in daily practice. No scores were calculated in only 10% of visits. Among the commonly used scores, the DAS28 had the highest influence on therapy decisions, followed by HAQ and FFbH (mean weight 6.62, 4.99 and 4.41, respectively).
In daily practice, rheumatologists very often take scores for disease activity (especially DAS28) and loss of physical function into consideration when deciding on treatment for patients with RA. However, scores for measuring structural changes or quality of life, are not yet very well established with German rheumatologists.
本研究聚焦于不同临床评分在类风湿关节炎（RA）患者日常治疗变更中的应用及影响，鉴于治疗选择有显著改善，实现病情缓解是一个可行目标。
在这项前瞻性研究中，分析了1467例年龄在15至88岁之间的RA患者（女性占72.5%，男性占27.5%），这些患者经历了治疗变更或首次接受改善病情抗风湿药（DMARD）治疗。在连续三次就诊时（T - 1、T0、T1），使用评分来评估疾病活动度、功能丧失、生活质量和影像学表现。此外，还探讨了评分对治疗变更的影响（数字评分量表，1 - 10）。
最常用的评分是DAS28（占所有就诊次数的65%）、汉诺威功能能力问卷（FFbH，36%）和HAQ（11%）。其他评估RA的评分在日常实践中相关性较小。仅10%的就诊未计算评分。在常用评分中，DAS28对治疗决策的影响最大，其次是HAQ和FFbH（平均权重分别为6.62、4.99和4.41）。
在日常实践中，风湿病学家在为RA患者决定治疗方案时，经常会考虑疾病活动度评分（尤其是DAS28）和身体功能丧失情况。然而，德国风湿病学家对测量结构变化或生活质量的评分尚未广泛应用。
