Wabe Nasir T, Sorich Michael J, Wechalekar Mihir D, Cleland Leslie G, McWilliams Leah, Lee Anita T Y, Spargo Llewellyn D, Metcalf Robert G, Hall Cindy, Proudman Susanna M, Wiese Michael D
From the School of Pharmacy and Medical Sciences, University of South Australia; Sansom Institute for Health Research, University of South Australia; School of Medicine, Flinders University; Department of Rheumatology, Royal Adelaide Hospital; Discipline of Medicine, University of Adelaide, Adelaide, Australia.N.T. Wabe, MPharm, MSc, PhD candidate, School of Pharmacy and Medical Sciences and Sansom Institute for Health Research; M.J. Sorich, PhD, Associate Professor, School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, and School of Medicine, Flinders University; M.D. Wechalekar, MBBS, MD, FRACP, School of Medicine, Flinders University; L.G. Cleland, PhD, Professor, Department of Rheumatology, Royal Adelaide Hospital; L. McWilliams, BN, Associate Clinical Services Coordinator, Department of Rheumatology, Royal Adelaide Hospital; A.T. Lee, MBBS (Hons), FRACP, PhD, Department of Rheumatology, Royal Adelaide Hospital, and Discipline of Medicine, University of Adelaide; L.D. Spargo, BSc (Hons), Department of Rheumatology, Royal Adelaide Hospital; R.G. Metcalf, PhD, Department of Rheumatology, Royal Adelaide Hospital; C. Hall, Department of Rheumatology, Royal Adelaide Hospital; S.M. Proudman, MBBS (Hons), FRACP, Associate Professor, Department of Rheumatology, Royal Adelaide Hospital, and Discipline of Medicine, University of Adelaide; M.D. Wiese, PhD, Associate Professor, School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia.
J Rheumatol. 2016 Sep;43(9):1643-9. doi: 10.3899/jrheum.151392. Epub 2016 Jul 15.
To investigate the association between adherence to treat-to-target (T2T) protocol and disease activity, functional outcomes, and radiographic outcomes in early rheumatoid arthritis (RA).
Data from a longitudinal cohort of patients with early RA were used. Adherence was determined at each followup visit over 3 years according to predefined criteria. The primary endpoint was remission according to Disease Activity Score in 28 joints (DAS28) and Simplified Disease Activity Index (SDAI) criteria. Functional and radiographic outcomes measured by modified Health Assessment Questionnaire and modified total Sharp score, respectively, were secondary endpoints.
A total of 198 patients with 3078 clinic visits over 3 years were included in this analysis. After adjusting for relevant variables, although there was no significant association between adherence to T2T and remission rate after 1 year, the associations reached significance after 3 years for both DAS28 (OR 1.71, 95% CI 1.16-2.50; p = 0.006) and SDAI criteria (OR 1.94, 95% CI 1.06-3.56; p = 0.033). After 3 years, adherence was also associated with improvement in physical function (β=0.12, 95% CI 0.06-0.18; p < 0.0001). None of the radiographic outcomes were associated with adherence after either 1 or 3 years, although there was a trend for higher adherence to be associated with less radiographic progression at the end of the study (p = 0.061).
Increased adherence to T2T was associated with better longterm disease activity and functional outcomes, which suggests that the benefit of a T2T protocol may be enhanced by ensuring adequate adherence.
探讨早期类风湿关节炎（RA）患者坚持治疗达标（T2T）方案与疾病活动度、功能结局及影像学结局之间的关联。
采用早期RA患者纵向队列的数据。根据预定义标准，在3年的每次随访中确定依从性。主要终点是根据28个关节疾病活动评分（DAS28）和简化疾病活动指数（SDAI）标准达到缓解。分别通过改良健康评估问卷和改良总Sharp评分测量的功能和影像学结局为次要终点。
本分析纳入了198例患者，在3年中共进行了3078次门诊就诊。在对相关变量进行调整后，虽然坚持T2T与1年后的缓解率之间无显著关联，但3年后，DAS28（比值比[OR]1.71，95%置信区间[CI]1.16 - 2.50；p = 0.006）和SDAI标准（OR 1.94，95% CI 1.06 - 3.56；p = 0.033）的关联均达到显著水平。3年后，依从性还与身体功能改善相关（β = 0.12，95% CI 0.06 - 0.18；p < 0.0001）。1年或3年后，影像学结局均与依从性无关，尽管在研究结束时，较高的依从性有与较少影像学进展相关的趋势（p = 0.061）。
增加对T2T方案的依从性与更好的长期疾病活动度和功能结局相关，这表明通过确保足够的依从性可能会增强T2T方案的益处。
