Kojima Masayo, Kojima Toshihisa, Suzuki Sadao, Takahashi Nobunori, Funahashi Koji, Asai Shuji, Yoshioka Yutaka, Terabe Kenya, Asai Nobuyuki, Takemoto Toki, Ishiguro Naoki
Department of Public Health Nagoya City University Graduate School of Medical Science, Nagoya University Hospital, Nagoya University School of Medicine, Nagoya, Japan.
Department of Orthopedic Surgery and Rheumatology, Nagoya University Hospital, Nagoya University School of Medicine, Nagoya, Japan.
Int J Rheum Dis. 2017 Sep;20(9):1193-1200. doi: 10.1111/1756-185X.12789. Epub 2015 Nov 6.
Whether the Boolean-based American College of Rheumatology/European League Against Rheumatism (EULAR) criteria for rheumatoid arthritis (RA) including patient-reported outcome measures (PROMs) for remission are strict for use in daily clinical practice is controversial. This study aimed to clarify the differences in the remission status defined by the criteria, including and excluding PROMs, and to identify the baseline predictors of long-term prognosis using 7-year follow-up data.
A total of 103 RA outpatients completed the baseline and 7-year follow-up questionnaire surveys. Pain visual analogue scale (VAS) of ≤ 1/10 was used as a PROM criterion for remission.
Only 10 patients achieved full-remission, whereas 18 met the partial-remission criteria excluding PROM at baseline. Although 70.0% of those who achieved full remission at baseline had full or partial remission status, 77.8% of those with partial remission were categorized as having no remission at 7 years. Significant baseline differences in the remission status at 7 years were observed with regard to disease duration, pain VAS, and physical function (Short Form 36 [SF-36]). Stepwise logistic regression analysis adjusted for age and sex identified disease duration and general health perception (SF-36) as independent predictors of full-remission.
Remission criteria including PROMs are stringent but important to achieve sustained remission. Early intensive treatment and efforts to improve patients' health perceptions may result in better prognosis for RA.
基于布尔运算的美国风湿病学会/欧洲抗风湿病联盟（EULAR）类风湿关节炎（RA）标准，包括用于缓解评估的患者报告结局指标（PROMs），在日常临床实践中的使用是否严格，存在争议。本研究旨在阐明包含和不包含PROMs的标准所定义的缓解状态差异，并利用7年随访数据确定长期预后的基线预测因素。
共有103例RA门诊患者完成了基线和7年随访问卷调查。疼痛视觉模拟量表（VAS）≤1/10被用作缓解的PROM标准。
仅10例患者达到完全缓解，而18例在基线时符合不包含PROMs的部分缓解标准。虽然基线时达到完全缓解的患者中有70.0%在7年时处于完全或部分缓解状态，但部分缓解的患者中有77.8%在7年时被归类为未缓解。在疾病持续时间、疼痛VAS和身体功能（简短健康调查问卷36项版[SF-36]）方面，观察到7年时缓解状态存在显著的基线差异。经年龄和性别调整的逐步逻辑回归分析确定疾病持续时间和总体健康感知（SF-36）为完全缓解的独立预测因素。
包含PROMs的缓解标准虽然严格，但对于实现持续缓解很重要。早期强化治疗和改善患者健康感知的努力可能会使RA患者获得更好的预后。
