早期缓解是大多数初治类风湿关节炎患者切实可行的目标。
Early Remission Is a Realistic Target in a Majority of Patients with DMARD-naive Rheumatoid Arthritis.
作者信息
Rannio Tuomas, Asikainen Juha, Kokko Arto, Hannonen Pekka, Sokka Tuulikki
机构信息
From the Jyväskylä Central Hospital, Jyväskylä, Finland.T. Rannio, MD, Head of Rheumatology Department; J. Asikainen, MD; A. Kokko, MD; P. Hannonen, Professor Emeritus of Rheumatology; T. Sokka, Professor of Rheumatology, Jyväskylä Central Hospital.
出版信息
J Rheumatol. 2016 Apr;43(4):699-706. doi: 10.3899/jrheum.141480. Epub 2016 Feb 15.
OBJECTIVE
We analyzed remission rates at 3 and 12 months in patients with rheumatoid arthritis (RA) who were naive for disease-modifying antirheumatic drugs (DMARD) and who were treated in a Finnish rheumatology clinic from 2008 to 2011. We compared remission rates and drug treatments between patients with RA and patients with undifferentiated arthritis (UA).
METHODS
Data from all DMARD-naive RA and UA patients from the healthcare district were collected using software that includes demographic and clinical characteristics, disease activity, medications, and patient-reported outcomes. Our rheumatology clinic applies the treat-to-target principle, electronic monitoring of patients, and multidisciplinary care.
RESULTS
Out of 409 patients, 406 had data for classification by the 2010 RA criteria of the American College of Rheumatology/European League Against Rheumatism. A total of 68% were female, and mean age (SD) was 58 (16) years. Respectively, 56%, 60%, and 68% were positive for anticyclic citrullinated peptide antibodies (anti-CCP), rheumatoid factor (RF), and RF/anti-CCP, and 19% had erosive disease. The median (interquartile range) duration of symptoms was 6 (4-12) months. A total of 310 were classified as RA and 96 as UA. The patients with UA were younger, had better functional status and lower disease activity, and were more often seronegative than the patients with RA. The 28-joint Disease Activity Score (3 variables) remission rates of RA and UA patients at 3 months were 67% and 58% (p = 0.13), and at 12 months, 71% and 79%, respectively (p = 0.16). Sustained remission was observed in 57%/56% of RA/UA patients. Patients with RA used more conventional synthetic DMARD combinations than did patients with UA. None used biological DMARD at 3 months, and only 2.7%/1.1% of the patients (RA/UA) used them at 12 months (p = 0.36).
CONCLUSION
Remarkably high remission rates are achievable in real-world DMARD-naive patients with RA or UA.
目的
我们分析了2008年至2011年期间在芬兰一家风湿病诊所接受治疗的初治抗风湿药物（DMARD）的类风湿关节炎（RA）患者在3个月和12个月时的缓解率。我们比较了RA患者和未分化关节炎（UA）患者的缓解率及药物治疗情况。
方法
使用包含人口统计学和临床特征、疾病活动度、用药情况以及患者报告结局的软件，收集了来自该医疗区所有初治DMARD的RA和UA患者的数据。我们的风湿病诊所采用达标治疗原则、患者电子监测以及多学科护理。
结果
在409例患者中，406例有数据可依据2010年美国风湿病学会/欧洲抗风湿病联盟的RA标准进行分类。共有68%为女性，平均年龄（标准差）为58（16）岁。抗环瓜氨酸肽抗体（抗CCP）、类风湿因子（RF）以及RF/抗CCP分别有56%、60%和68%呈阳性，19%有侵蚀性疾病。症状的中位（四分位间距）持续时间为6（4 - 12）个月。共有310例被分类为RA，96例为UA。UA患者比RA患者更年轻，功能状态更好，疾病活动度更低，且血清学阴性的情况更常见。RA和UA患者在3个月时的28关节疾病活动评分（3个变量）缓解率分别为67%和58%（p = 0.13），在12个月时分别为71%和79%（p = 0.16）。在57%/56%的RA/UA患者中观察到持续缓解。RA患者比UA患者使用更多传统合成DMARD联合用药。3个月时无人使用生物DMARD，12个月时仅有2.7%/1.1%的患者（RA/UA）使用（p = 0.36）。
结论
在现实世界中初治DMARD的RA或UA患者可实现相当高的缓解率。
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