Shidara Kumi, Nakajima Ayako, Inoue Eisuke, Hoshi Daisuke, Sugimoto Naoki, Seto Yohei, Tanaka Eiichi, Momohara Shigeki, Taniguchi Atsuo, Yamanaka Hisashi
From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.
H. Yamanaka has received research grants from Astellas Pharma Inc. and Bristol-Myers-Squibb.
J Rheumatol. 2017 Feb;44(2):147-153. doi: 10.3899/jrheum.160395. Epub 2016 Dec 1.
To evaluate longterm functional outcomes in rheumatoid arthritis (RA) based on the number of times that the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) or the 28-joint Disease Activity Score (DAS28) remission criteria were fulfilled.
Patients with RA who participated in all 6 data collections in an observational cohort from 2008 to 2010 and who fulfilled the DAS28 remission criteria at baseline were studied. Patients were classified by the number of times they fulfilled the ACR/EULAR [Boolean trial, Boolean practice, Simplified Disease Activity Index (SDAI), or Clinical Disease Activity Index (CDAI)] or DAS28 remission criteria at each collection. The OR for the Japanese version of the Health Assessment Questionnaire (J-HAQ) progression, based on the number of times each set of remission criteria was fulfilled, were calculated by logistic regression.
A total of 915 patients were studied. The OR (95% CI) for J-HAQ progression were 0.54 (0.33-0.87), 0.55 (0.33-0.92), 0.48 (0.28-0.82), 0.29 (0.16-0.51), 0.24 (0.13-0.47), and 0.07 (0.03-0.15) for those fulfilling the Boolean trial remission from 1 to 6 times. This tendency was also observed for the other 4 criteria. The OR (95% CI) for J-HAQ progression in patients who achieved remission at all 6 data collections were 0.07 (0.03-0.14) for the Boolean practice, 0.10 (0.05-0.20) for the SDAI, and 0.07 (0.04-0.15) for the CDAI, whereas 0.15 (0.08-0.29) for the DAS28.
Continual fulfillment of any remission criteria was strongly effective in preventing patients from progression of functional disability; however, the ACR/EULAR criteria appear to be preferable.
根据美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）缓解标准或28关节疾病活动评分（DAS28）缓解标准的达成次数，评估类风湿关节炎（RA）的长期功能结局。
对2008年至2010年参与一项观察性队列研究所有6次数据收集且在基线时达到DAS28缓解标准的RA患者进行研究。根据患者在每次数据收集时达到ACR/EULAR[布尔试验、布尔实践、简化疾病活动指数（SDAI）或临床疾病活动指数（CDAI）]或DAS28缓解标准的次数进行分类。基于每组缓解标准的达成次数，通过逻辑回归计算日本版健康评估问卷（J-HAQ）进展的比值比（OR）。
共研究了915例患者。对于达到布尔试验缓解1至6次的患者，J-HAQ进展的OR（95%置信区间）分别为0.54（0.33-0.87）、0.55（0.33-0.92）、0.48（0.28-0.82）、0.29（0.16-0.51）、0.24（0.13-0.47）和0.07（0.03-0.15）。其他4项标准也观察到这种趋势。在所有6次数据收集时均达到缓解的患者中，布尔实践的J-HAQ进展OR（95%置信区间）为0.07（0.03-0.14），SDAI为0.10（0.05-0.20），CDAI为0.07（0.04-0.15），而DAS28为0.15（0.08-0.29）。
持续达成任何缓解标准对防止患者功能残疾进展非常有效；然而，ACR/EULAR标准似乎更优。
