类风湿关节炎患者感知的病情加重：STRASS 治疗逐渐停药策略试验的亚分析。
Patient-perceived flares in rheumatoid arthritis: A sub-analysis of the STRASS treatment tapering strategy trial.
机构信息
Sorbonne Universités, UPMC Université Paris 06, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), 75013 Paris, France; Department of rheumatology, Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; Rheumatology Department, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France; Brest University, Rheumatology Department, La Cavale-Blanche University Hospital, 29000 Brest, France.
Sorbonne Universités, UPMC Université Paris 06, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), 75013 Paris, France; Department of rheumatology, Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; Brest University, Rheumatology Department, La Cavale-Blanche University Hospital, 29000 Brest, France.
出版信息
Joint Bone Spine. 2017 Oct;84(5):577-581. doi: 10.1016/j.jbspin.2016.10.001. Epub 2016 Dec 5.
OBJECTIVES
Patient's and physician's perspective can differ in rheumatoid arthritis (RA). The aim was to define the concept of patient-reported flares.
METHODS
Post-hoc analysis of a randomized controlled trial of a step-down strategy in RA patients treated with anti-TNF, in DAS28-remission for ≥6 months, randomized to either "spacing" or "maintaining" anti-TNF. The occurrence of patient-reported flares (PRF) was evaluated every 3 months for 18 months by: "Over the last 3 months, did you experience symptoms suggestive of disease exacerbation?". Visits with and without PRF were compared, using a linear mixed effects model, in terms of symptoms, disability based on the Health Assessment Questionnaire, quality of life based on Short Form 36 Health Survey and DAS28-based relapses (DBR), defined as an increase of DAS28>0.6 and an absolute value of DAS28>2.6. The agreement between PRF and DBR was measured by the kappa coefficient on repeated data.
RESULTS
In all, 137 patients were analyzed: mean age 55±11 years, females 78%, mean RA duration 9.5±8.0 years. Over the 18 months, PRF concerned 27.2% of the 940 available visits. DBR and PRF were observed in 24% and 16% of 940 visits for 137 patients respectively. All the items were associated with PRF with standardized effect size between -0.58 (SF36 PCS) and 0.87 (DAS28). The agreement between PRF and DBR was moderate (κ=0.44).
CONCLUSION
The concept of flare refers to more than just RA disease activity.
目的
类风湿关节炎（RA）患者和医生的观点可能存在差异。本研究旨在定义患者报告的缓解期（PRF）的概念。
方法
这是一项抗 TNF 治疗的 RA 患者降阶梯策略的随机对照试验的事后分析，患者在 DAS28 缓解≥6 个月后，随机分为“间隔”或“维持”抗 TNF。在 18 个月的时间里，每 3 个月通过“在过去的 3 个月里，您是否经历过疾病恶化的症状？”来评估患者报告的缓解期（PRF）的发生情况。使用线性混合效应模型比较有和无 PRF 的就诊情况，比较指标包括症状、基于健康评估问卷（HAQ）的残疾、基于 36 项简明健康调查问卷（SF36）的生活质量和基于 DAS28 的复发（DBR），定义为 DAS28 增加>0.6 和 DAS28 的绝对值>2.6。通过重复数据的kappa 系数来衡量 PRF 和 DBR 之间的一致性。
结果
共分析了 137 例患者：平均年龄 55±11 岁，女性占 78%，RA 病程平均为 9.5±8.0 年。在 18 个月的时间里，940 次就诊中有 27.2%的患者出现了 PRF。在 137 例患者的 940 次就诊中，分别有 24%和 16%观察到了 DBR 和 PRF。所有项目均与 PRF 相关，标准化效应大小在-0.58（SF36 PCS）至 0.87（DAS28）之间。PRF 和 DBR 之间的一致性为中度（κ=0.44）。
结论
缓解期的概念不仅仅指 RA 疾病活动度。
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