Son Kyeong Min, Lee Sung Yeon, Seo Young Il, Choi Ji-Eun, Kim Hyun Ah
Division of Rheumatology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Kyunggi, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896, Pyongchon, Anyang Kyunggi, 431-070, Republic of Korea.
Clin Rheumatol. 2017 Jun;36(6):1221-1227. doi: 10.1007/s10067-017-3628-3. Epub 2017 Apr 27.
We investigated the contributions made by the subjective components of the Disease Activity Score 28 (DAS28) to the treatment response of rheumatoid arthritis (RA). In addition, factors associated with poor response to treatment at 6 months, despite normalization of objective measures, were examined. A total of 426 newly diagnosed RA patients were included. The DAS28-P score (the subjective components of the DAS28 relative to the total components) was calculated as DAS28-P = 0.56 ∗ sqrt(TJC28) + 0.014 ∗ (VAS-GH) /0.56 ∗ sqrt(TJC28) + 0.28 ∗ sqrt(SJC28) + 0.7 ∗ In(erythrocyte sedimentation rate (ESR)) + 0.014 ∗ (VAS-GH). The European League Against Rheumatism (EULAR) response was assessed after 6 months of treatment. Of those who failed to attain good EULAR responses, those for whom the objective measures (the ESR, the C-reactive protein level, and swollen joints) were normalized were defined as having failed treatment because of subjective measures. The median (IQR) DAS28 score at baseline was 4.8 (4.04-5.49) and that after 6 months of treatment 3.21 (2.41-3.95). The DAS28-P score fell significantly from baseline to 6 months in good (0.43 versus 0.28, p < 0.001) and moderate responders (0.44 versus 0.4, p = 0.003), but not in non-responders (0.43 versus 0.45, p = 0.727). Younger age, a lower DAS28 score, and a lower DAS28-P score at baseline were related to a good EULAR response. Subjects who failed to respond because of subjective measures tended to have higher DAS28-P scores at baseline. We found that RA patients with high DAS28-P scores, reflecting subjective measures, were less likely to achieve good EULAR responses 6 months after treatment initiation and tended not to be classified as good responders despite normalization of objective measures.
我们研究了疾病活动评分28（DAS28）的主观成分对类风湿关节炎（RA）治疗反应的影响。此外，还研究了尽管客观指标已恢复正常，但在6个月时治疗反应不佳的相关因素。共纳入426例新诊断的RA患者。DAS28-P评分（DAS28的主观成分相对于总成分）的计算方法为：DAS28-P = 0.56 * sqrt（TJC28）+ 0.014 *（VAS-GH）/ 0.56 * sqrt（TJC28）+ 0.28 * sqrt（SJC28）+ 0.7 * In（红细胞沉降率（ESR））+ 0.014 *（VAS-GH）。治疗6个月后评估欧洲抗风湿病联盟（EULAR）反应。在那些未达到良好EULAR反应的患者中，客观指标（ESR、C反应蛋白水平和肿胀关节）已恢复正常的患者被定义为因主观指标而治疗失败。基线时DAS28评分的中位数（IQR）为4.8（4.04 - 5.49），治疗6个月后为3.21（2.41 - 3.95）。在良好反应者（0.43对0.28，p < 0.001）和中度反应者（0.44对0.4，p = 0.003）中，DAS28-P评分从基线到6个月显著下降，但在无反应者中未下降（0.43对0.45，p = 0.727）。年龄较小、基线时DAS28评分较低和DAS28-P评分较低与良好的EULAR反应相关。因主观指标而无反应的患者在基线时往往具有较高的DAS28-P评分。我们发现，反映主观指标的高DAS28-P评分的RA患者在开始治疗6个月后不太可能获得良好的EULAR反应，并且尽管客观指标已恢复正常，但往往不被归类为良好反应者。
