类风湿关节炎患者在临床实践中达到缓解和低疾病活动度定义的情况：NOR-DMARD研究结果
Achievement of Remission and Low Disease Activity Definitions in Patients with Rheumatoid Arthritis in Clinical Practice: Results from the NOR-DMARD Study.
作者信息
Uhlig Till, Lie Elisabeth, Norvang Vibeke, Lexberg Åse Stavland, Rødevand Erik, Krøll Frode, Kalstad Synøve, Olsen Inge C, Kvien Tore K
机构信息
From the National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Department of Rheumatology, Buskerud Central Hospital, Drammen; Department of Rheumatology, St. Olavs Hospital, Trondheim; Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer; Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway.T. Uhlig, MD, Professor, Chief Consultant, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; E. Lie, MD, PhD, Fellow, Department of Rheumatology, Diakonhjemmet Hospital; V. Norvang, MD, Intern, Department of Rheumatology, Diakonhjemmet Hospital; Å.S. Lexberg, MD, Consultant, Department of Rheumatology, Buskerud Central Hospital; E. Rødevand, MD, Head of Department, Department of Rheumatology, St. Olavs Hospital; F. Krøll, MD, Head of Department, Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases; S. Kalstad, MD, Head of Department, Department of Rheumatology, University Hospital of Northern Norway, University Hospital of Northern Norway; I.C. Olsen, MSc, PhD, Senior Researcher, Department of Rheumatology, Diakonhjemmet Hospital; T.K. Kvien, MD, Professor, Head of Department, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo.
出版信息
J Rheumatol. 2016 Apr;43(4):716-23. doi: 10.3899/jrheum.151132. Epub 2016 Feb 15.
OBJECTIVE
To examine the frequency of 6 definitions for remission and 4 definitions for low disease activity (LDA) after starting a disease-modifying antirheumatic drug (DMARD) in patients with rheumatoid arthritis (RA) in clinical practice, and to study whether predictors for achieving remission after 6 months are similar for these definitions.
METHODS
Remission and LDA were calculated according to the 28-joint Disease Activity Score (DAS28), the Clinical Disease Activity Index (CDAI), the Simplified Disease Activity Index (SDAI), the Routine Assessment of Patient Index Data (RAPID3), and both the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean remission definitions 3 and 6 months after 4992 DMARD prescriptions for patients enrolled in the NOR-DMARD, a 5-center Norwegian register. Prediction of remission after 6 months was also studied.
RESULTS
After 3 months, remission rates varied between definitions from 8.7% to 22.5% and for LDA from 35.5% to 42.7%, and increased slightly until 6 months of followup. DAS28 and RAPID3 gave the highest and ACR/EULAR, SDAI, and CDAI the lowest proportions for remission. Positive predictors for remission after 6 months were similar across the definitions and included lower age, male sex, short disease duration, high level of education, current nonsmoking, nonerosive disease, treatment with a biological DMARD, being DMARD-naive, good physical function, little fatigue, and LDA.
CONCLUSION
In daily clinical practice, the DAS28 and RAPID3 definitions identified remission about twice as often as the ACR/EULAR Boolean, SDAI, and CDAI. Predictors of remission were similar across remission definitions. These findings provide additional evidence to follow treatment recommendations and treat RA early with a DMARD.
目的
在临床实践中，研究类风湿关节炎（RA）患者开始使用改善病情抗风湿药物（DMARD）后，6种缓解定义和4种低疾病活动度（LDA）定义的出现频率，并研究这些定义在6个月后实现缓解的预测因素是否相似。
方法
根据28个关节的疾病活动评分（DAS28）、临床疾病活动指数（CDAI）、简化疾病活动指数（SDAI）、患者指数数据的常规评估（RAPID3），以及美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）的布尔缓解定义，对挪威5中心登记处NOR-DMARD中4992例DMARD处方患者在用药3个月和6个月后的缓解和LDA情况进行计算。同时研究6个月后缓解的预测情况。
结果
3个月后，缓解率在不同定义之间为8.7%至22.5%，LDA率为35.5%至42.7%，并在随访至6个月时略有增加。DAS28和RAPID3给出的缓解比例最高，而ACR/EULAR、SDAI和CDAI给出的比例最低。6个月后缓解的阳性预测因素在各定义之间相似，包括年龄较小、男性、病程短、教育程度高、当前不吸烟、无侵蚀性疾病、使用生物DMARD治疗、未使用过DMARD、身体功能良好、疲劳少以及LDA。
结论
在日常临床实践中，DAS28和RAPID3定义识别出缓解的频率约为ACR/EULAR布尔定义、SDAI和CDAI的两倍。缓解的预测因素在不同缓解定义之间相似。这些发现为遵循治疗建议并早期使用DMARD治疗RA提供了更多证据。
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