Mohammed Reem Hamdy A, Farahat Faisal, Kewan Hanady H, Bukhari Mohammed A
Rheumatology and Clinical Immunology, Department of Rheumatology and Rehabilitation, School of Medicine, Cairo University Hospitals, Cairo, Egypt ; Internal Medicine Department, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia.
Community Medicine, Munofia University, Munofia, Egypt ; Research Department Al Hada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia.
Springerplus. 2015 May 1;4:207. doi: 10.1186/s40064-015-0979-6. eCollection 2015.
The aim of this study was to survey factors related to EULAR good response, the DAS-28 definition of remission, ACR 50 response, sustained response to tumor necrosis factor inhibitors (TNF-I) therapy in biologic naïve patients with refractory rheumatoid arthritis. This was a single center observational clinical prospective 2 years' study, EULAR response criteria, DAS 28, HAQ and radiographic changes were recorded. Eighty patients included (64 females and 16 males, mean age was 48.4 + -17.9 years, mean disease duration 7.3 + -5.9 years). At 6 months 70% achieved EULAR good response, 51.8% achieved DAS-28 remission. Good response/sustained responses inversely correlated with baseline DAS-28 and radiographic erosions P <0.05. EULAR good response/remission by 6 months, sustained response at 2 years positively correlated with the decline in RF titers (r = 0.33, P < 0.05 & r = 0.30, P < 0.03 respectively), negatively correlated with the baseline HAQ. Regression analysis identified higher serum hemoglobin concentration, lower baseline HAQ scores, and the absence of radiographic erosions as significant predictors of good as well as sustained responses after adjustment for potential covariates. Methotrexate was associated with favorable responses and remission at 6 months (ORs = 1.13, 1.30 respectively). The study concluded that a lower baseline DAS-28 and HAQ scores, the lack of radiographic erosions favored EULAR good response and were significant predictors of sustained response to TNF-I.
本研究旨在调查与欧洲抗风湿病联盟（EULAR）良好反应、疾病活动评分28（DAS-28）缓解定义、美国风湿病学会（ACR）50反应、初治生物制剂的难治性类风湿关节炎患者对肿瘤坏死因子抑制剂（TNF-I）治疗的持续反应相关的因素。这是一项单中心观察性临床前瞻性2年研究，记录了EULAR反应标准、DAS 28、健康评估问卷（HAQ）和影像学变化。纳入80例患者（64例女性和16例男性，平均年龄48.4±17.9岁，平均病程7.3±5.9年）。6个月时，70%的患者达到EULAR良好反应，51.8%的患者达到DAS-28缓解。良好反应/持续反应与基线DAS-28和影像学侵蚀呈负相关，P<0.05。6个月时达到EULAR良好反应/缓解、2年时达到持续反应与类风湿因子（RF）滴度下降呈正相关（r分别为0.33，P<0.05和r为0.30，P<0.03），与基线HAQ呈负相关。回归分析确定，在对潜在协变量进行调整后，较高的血清血红蛋白浓度、较低的基线HAQ评分以及无影像学侵蚀是良好反应和持续反应的重要预测因素。甲氨蝶呤与6个月时的良好反应和缓解相关（比值比分别为1.13、1.30）。研究得出结论，较低的基线DAS-28和HAQ评分、无影像学侵蚀有利于EULAR良好反应，并且是对TNF-I持续反应的重要预测因素。
