在接受肿瘤坏死因子抑制剂治疗的类风湿关节炎患者中，联合使用甲氨蝶呤可预防全膝关节置换术。
Concomitant Methotrexate Protects Against Total Knee Arthroplasty in Patients with Rheumatoid Arthritis Treated with Tumor Necrosis Factor Inhibitors.
作者信息
Asai Shuji, Takahashi Nobunori, Funahashi Koji, Yoshioka Yutaka, Takemoto Toki, Terabe Kenya, Asai Nobuyuki, Ishiguro Naoki, Kojima Toshihisa
机构信息
From the Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.S. Asai, MD, PhD, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; N. Takahashi, MD, PhD, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; K. Funahashi, MD, PhD, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; Y. Yoshioka, MD, PhD, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; T. Takemoto, MD, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; K. Terabe, MD, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; N. Asai, MD, PhD, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; N. Ishiguro, MD, PhD, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; T. Kojima, MD, PhD, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine.
出版信息
J Rheumatol. 2015 Dec;42(12):2255-60. doi: 10.3899/jrheum.150410. Epub 2015 Oct 1.
OBJECTIVE
To determine the effects of concomitant methotrexate (MTX) on the incidence of total knee arthroplasty (TKA) resulting from the progression of joint destruction in patients with rheumatoid arthritis (RA) during longterm treatment with tumor necrosis factor (TNF) inhibitors.
METHODS
A total of 155 patients with RA (310 knee joints) received TNF inhibitors at our institute between May 1, 2001, and May 31, 2008. A total of 111 symptomatic (tender and/or swollen) knee joints in 68 patients were retrospectively studied over the course of a minimum of 5 years of followup. The median (interquartile range) followup period was 8.1 (7.0-9.3) years. All data were analyzed using the knee joint as the statistical unit of analysis. TKA during treatment with TNF inhibitors was used as the outcome variable in predictive analyses. The cumulative incidence of TKA was compared by concomitant or no MTX use (MTX±).
RESULTS
There were 79 subjects (71%) who received concomitant MTX. According to Kaplan-Meier estimates, the cumulative incidence of TKA for the MTX+ group was significantly lower than that for the MTX- group (24% vs 45% at 5 yrs, respectively, p = 0.035). Multivariate analysis using the Cox proportional hazards model revealed that concomitant MTX (HR 0.44, 95% CI 0.22-0.89), Larsen grade (HR 2.93, 95% CI 1.94-4.41), and older age at baseline (HR 1.04, 95% CI 1.01-1.08) were independent predictors of TKA.
CONCLUSION
Concomitant MTX reduces the incidence of TKA by 56% in patients with RA during longterm treatment with TNF inhibitors.
目的
确定在类风湿关节炎（RA）患者长期使用肿瘤坏死因子（TNF）抑制剂治疗期间，联合使用甲氨蝶呤（MTX）对关节破坏进展导致的全膝关节置换术（TKA）发生率的影响。
方法
2001年5月1日至2008年5月31日期间，共有155例RA患者（310个膝关节）在我院接受了TNF抑制剂治疗。对68例患者中111个有症状（压痛和/或肿胀）的膝关节进行了回顾性研究，随访时间至少5年。中位（四分位间距）随访期为8.1（7.0 - 9.3）年。所有数据以膝关节作为统计分析单位进行分析。在预测分析中，将TNF抑制剂治疗期间的TKA用作结局变量。比较联合使用或未使用MTX（MTX±）时TKA的累积发生率。
结果
79名受试者（71%）联合使用了MTX。根据Kaplan-Meier估计，MTX+组TKA的累积发生率显著低于MTX-组（5年时分别为24%和45%，p = 0.035）。使用Cox比例风险模型进行的多变量分析显示，联合使用MTX（风险比[HR] 0.44，95%置信区间[CI] 0.22 - 0.89）、Larsen分级（HR 2.93，95% CI 1.94 - 4.41）和基线时年龄较大（HR 1.04，95% CI 1.01 - 1.08）是TKA的独立预测因素。
结论
在RA患者长期使用TNF抑制剂治疗期间，联合使用MTX可使TKA发生率降低56%。
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