Wendling Daniel, Guillot Xavier, Gossec Laure, Prati Clément, Saraux Alain, Dougados Maxime
Department of Rheumatology, CHRU de Besançon, University Teaching Hospital, Boulevard Fleming, 25030 Besançon, France; Université de Franche-Comté, 25030 Besançon, France.
Department of Rheumatology, CHRU de Besançon, University Teaching Hospital, Boulevard Fleming, 25030 Besançon, France.
Joint Bone Spine. 2017 Jul;84(4):473-476. doi: 10.1016/j.jbspin.2016.06.004. Epub 2016 Jul 21.
No evaluation of factors associated with remission has been performed in early SpA. The aim of the study was to evaluate percentage of patients in remission using and comparing different definitions of remission, and to evaluate factors associated with remission at inclusion in the prospective DESIR cohort, and after 24 months.
Performance of three definitions (ASAS partial remission [PR], ASDAS-CRP less than 1.3 [ASDAS-R], BASDAI less than 3.6 [BASDAI-R]) were assessed using sensibility, specificity and Youden Index. Data at M0 and M24 were analyzed in uni- and multivariate analysis.
Seven hundred and six patients were evaluated at M0 and 577 at M24. At M0, percentage of patients in remission was 4% (PR), 8% (ASDAS), 34% (BASDAI), and at M24: 15%, 24% and 54% respectively, in the whole population and similar in Amor, ESSG and ASAS classified patients. BASDAI less than 3.6 had the best sensitivity, and ASDAS-R the best Youden index when using each of the two other definitions of remission as a gold standard. At M24 in multivariate analysis, remission was associated with less smoking, less analgesics, ASAS clinical arm fulfilling, less NSAIDs (ASDAS-R), low CRP (ASDAS-R), low BMI (BASDAI-R). However, over the two years, this study did not allow to demonstrate a relation between remission and structural progression or morbidity.
In this population suggestive of early SpA, smoking and CRP appear as major markers of disease activity in early SpA, and associated with absence of remission.
尚未对早期脊柱关节炎（SpA）缓解相关因素进行评估。本研究旨在使用并比较不同的缓解定义来评估缓解患者的百分比，并评估前瞻性DESIR队列纳入时以及24个月后与缓解相关的因素。
使用敏感性、特异性和尤登指数评估三种定义（ASAS部分缓解[PR]、ASDAS-CRP小于1.3[ASDAS-R]、BASDAI小于3.6[BASDAI-R]）的性能。对M0和M24的数据进行单变量和多变量分析。
M0时评估了706例患者，M24时评估了577例患者。在M0时，整个队列中缓解患者的百分比分别为4%（PR）、8%（ASDAS）、34%（BASDAI），在M24时分别为15%、24%和54%，在根据Amor、ESSG和ASAS分类的患者中情况类似。当将其他两种缓解定义中的每一种作为金标准时，BASDAI小于3.6具有最佳敏感性，ASDAS-R具有最佳尤登指数。在M24的多变量分析中，缓解与吸烟较少、使用镇痛药较少、符合ASAS临床标准、使用非甾体抗炎药较少（ASDAS-R）、CRP较低（ASDAS-R）、BMI较低（BASDAI-R）相关。然而，在这两年中，本研究未能证明缓解与结构进展或发病率之间的关系。
在这个提示早期SpA的队列中，吸烟和CRP似乎是早期SpA疾病活动的主要标志物，且与未缓解相关。
