Rannio T, Asikainen J, Hannonen P, Yli-Kerttula T, Ekman P, Pirilä L, Kuusalo L, Mali M, Puurtinen-Vilkki M, Kortelainen S, Paltta J, Taimen K, Kauppi M, Laiho K, Nyrhinen S, Mäkinen H, Isomäki P, Uotila T, Aaltonen K, Kautiainen H, Sokka T
a Department of Rheumatology , Central Hospital of Central Finland , Jyväskylä , Finland.
b Department of Rheumatology , Satakunta Central Hospital , Rauma , Finland.
Scand J Rheumatol. 2017 Nov;46(6):425-431. doi: 10.1080/03009742.2016.1266029. Epub 2017 Apr 3.
To assess what proportion of patients with disease-modifying anti-rheumatic drug (DMARD)-naïve early rheumatoid arthritis (ERA) reach 28-joint Disease Activity Score (DAS28) remission over 1 year, and remission variability across clinics in Finland.
Patients with DMARD-naïve newly diagnosed inflammatory arthritis were recruited. The proportion of patients in 28-joint Disease Activity Score with three variables (DAS28-3) remission was compared across sites. Repeated measures were analysed using a mixed models approach with appropriate distribution and link function.
In total, 611 patients were recruited at five sites: 67% were female; the mean (sd) age was 57 (16) years; 71% and 68% were positive for rheumatoid factor and anti-cyclic citrullinated peptides, respectively; and 23% had radiographic erosions. A total of 506 (83%) fulfilled the American College of Rheumatology/European League Against Rheumatism 2010 classification criteria for rheumatoid arthritis for further analyses. DAS28-3 remission was met by 68% and 75% at 3 and 12 months, respectively. The clinical site had no effect on remission when adjusted for confounders. At baseline, 68% used methotrexate-based combination therapy, and 31% used triple therapy with methotrexate, hydroxychloroquine, and sulphasalazine (the Fin-RACo regimen). In multivariate analysis, the only independent predictors of DAS28-3 remission at 12 months were lower baseline DAS28-3 and triple therapy as the initial treatment.
Three out of four DMARD-naïve ERA patients in Finland are in remission during the first year from the diagnosis. High remission rates were achieved for most patients with the use of conventional synthetic DMARDs in combination. Treatment of DMARD-naïve ERA patients with the FIN-RACo regimen is a predictor of DAS28-3 remission in real-life rheumatology settings.
评估初治的疾病改善抗风湿药物（DMARD）的早期类风湿关节炎（ERA）患者在1年内达到28个关节疾病活动评分（DAS28）缓解的比例，以及芬兰各诊所间缓解情况的差异。
招募初治的新诊断炎性关节炎患者。比较各研究点达到28个关节疾病活动评分三个变量（DAS28-3）缓解的患者比例。采用具有适当分布和连接函数的混合模型方法分析重复测量数据。
共在5个研究点招募了611例患者：67%为女性；平均（标准差）年龄为57（16）岁；类风湿因子和抗环瓜氨酸肽阳性率分别为71%和68%；23%有影像学侵蚀。共有506例（83%）符合美国风湿病学会/欧洲抗风湿病联盟2010年类风湿关节炎分类标准，用于进一步分析。3个月和12个月时DAS28-3缓解率分别为68%和75%。校正混杂因素后，临床研究点对缓解情况无影响。基线时，68%的患者使用基于甲氨蝶呤的联合治疗，31%的患者使用甲氨蝶呤、羟氯喹和柳氮磺胺吡啶三联疗法（芬兰类风湿关节炎联合治疗方案）。在多变量分析中，12个月时DAS28-3缓解的唯一独立预测因素是较低的基线DAS28-3以及初始治疗采用三联疗法。
芬兰四分之三初治的ERA患者在诊断后的第一年病情缓解。大多数患者联合使用传统合成DMARDs可实现高缓解率。在实际风湿病治疗中，采用芬兰类风湿关节炎联合治疗方案治疗初治的ERA患者是DAS28-3缓解的一个预测因素。
