通过RAPID3和其他核心数据集指标预测法国早期关节炎队列中的病情缓解情况，而非通过类风湿因子、抗瓜氨酸化蛋白抗体或影像学侵蚀的缺失情况进行预测。
Prediction of Remission in a French Early Arthritis Cohort by RAPID3 and other Core Data Set Measures, but Not by the Absence of Rheumatoid Factor, Anticitrullinated Protein Antibodies, or Radiographic Erosions.
作者信息
Castrejón Isabel, Dougados Maxime, Combe Bernard, Fautrel Bruno, Guillemin Francis, Pincus Theodore
机构信息
From the Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA; Paris Descartes University; Department of Rheumatology, Hôpital Cochin; Assistance Publique, Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; Pitie-Salpetriere University Hospital, Paris; Department of Rheumatology, CHU Lapeyronie, Montpellier University, Montpellier; University of Lorraine, EA 4360 APEMAC, Nancy, France.I. Castrejón, MD, PhD, Division of Rheumatology, Rush University Medical Center; M. Dougados, MD, PhD, Paris Descartes University, and Department of Rheumatology, Hôpital Cochin, and Assistance Publique, Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité; B. Combe, MD, PhD, Department of Rheumatology, CHU Lapeyronie, Montpellier University; B. Fautrel, MD, PhD, APHP, Pitie-Salpetriere University Hospital; F. Guillemin, MD, PhD, University of Lorraine, EA 4360 APEMAC; T. Pincus, MD, Division of Rheumatology, Rush University Medical Center.
出版信息
J Rheumatol. 2016 Jul;43(7):1285-91. doi: 10.3899/jrheum.141586. Epub 2016 Apr 15.
OBJECTIVE
To identify baseline variables that predict remission according to different criteria in rheumatoid arthritis (RA) in a comprehensive French ESPOIR early arthritis database.
METHODS
Individual variables and indices at baseline were analyzed in 664 patients for capacity to predict remission either 6 or 12 months later according to 4 criteria that require a formal joint count: the American College of Rheumatology/European League Against Rheumatism Boolean criteria, the Simplified Disease Activity Index, the Clinical Disease Activity Index, and the 28-joint Disease Activity Score; and 2 remission criteria that do not require a formal joint count: the Routine Assessment of Patient Index Data 3 (RAPID3) and the RAPID3 ≤ 3 + swollen joint, using univariate and multivariate logistic regressions.
RESULTS
Remission was predicted significantly 6 and/or 12 months later in 26.8%-51.4% of patients, according to all 6 criteria by younger age, low index scores, and better status for the 6/7 clinical RA core dataset measures: tender joint count, swollen joint count (SJC), physician's global estimate, patient self-report Health Assessment Questionnaire (HAQ) physical function, pain, and patient's global estimate. Remission was not predicted by the absence of "poor prognosis RA" indicators, rheumatoid factor (RF), anticitrullinated protein antibodies (ACPA), or radiographic erosions. In multivariate regressions that included only 3 variables, low HAQ function predicted remission by all criteria as effectively as SJC, erythrocyte sedimentation rate, or C-reactive protein.
CONCLUSION
Younger age and 6 core dataset clinical measures, but not the absence of traditional "poor prognosis RA" indicators, RF, ACPA, or radiographic erosions, predicted remission according to 6 criteria, including 2 without a formal joint count.
目的
在一个全面的法国ESPOIR早期关节炎数据库中，确定根据不同标准预测类风湿关节炎（RA）缓解情况的基线变量。
方法
对664例患者的基线个体变量和指标进行分析，以根据4种需要正式关节计数的标准预测6个月或12个月后的缓解情况：美国风湿病学会/欧洲抗风湿病联盟布尔标准、简化疾病活动指数、临床疾病活动指数和28关节疾病活动评分；以及2种不需要正式关节计数的缓解标准：患者指数数据3常规评估（RAPID3）和RAPID3≤3+肿胀关节，采用单变量和多变量逻辑回归分析。
结果
根据所有6种标准，26.8%-51.4%的患者在6个月和/或12个月后被显著预测为缓解，这些标准包括年龄较小、指数得分较低以及6/7项临床RA核心数据集指标的状况较好：压痛关节计数、肿胀关节计数（SJC）、医生整体评估、患者自我报告健康评估问卷（HAQ）身体功能、疼痛和患者整体评估。“预后不良RA”指标、类风湿因子（RF）、抗瓜氨酸化蛋白抗体（ACPA）或影像学侵蚀的缺失并不能预测缓解情况。在仅包含3个变量的多变量回归中，低HAQ功能与SJC、红细胞沉降率或C反应蛋白一样，能有效预测所有标准下的缓解情况。
结论
年龄较小和6项核心数据集临床指标可预测缓解情况，包括2种无需正式关节计数的标准，但传统“预后不良RA”指标、RF、ACPA或影像学侵蚀的缺失则不能，根据6种标准进行预测。
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