Division of Rheumatology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
Division of Rheumatology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
Semin Arthritis Rheum. 2017 Dec;47(3):310-314. doi: 10.1016/j.semarthrit.2017.04.008. Epub 2017 Apr 28.
The aim of the study is to assess the factors associated with clinical remission of patients with rheumatoid arthritis (RA) in daily clinical practice.
This analysis was based on the data of 304 RA patients in our center between May 2014 and March 2015. The following information was included: tender, swollen, and symptomatic joint counts, patient's and physician's global assessments, functional disability, laboratory and radiographic data, and RA treatments received.
The patients were predominantly female (77.6%), with a median age of 71 years and a median disease duration of 5.8 years. Clinical remission rate, determined using the simplified disease activity index (SDAI), was 49.7%. Patient's and physician's global assessments (/10cm) showed a higher score among patients who did not achieve SDAI remission than among those who did (median: 3.2 versus 0.3, p < 0.0001; and median: 1.8 versus 0.3, p < 0.0001, respectively). The contribution of serum C-reactive protein values (mg/dL) to SDAI was limited (median: 0.19 versus 0.06; p < 0.0001), as well as tender or swollen joint counts (median = 0 or 1). On multivariate analysis of factors not directly related to the disease activity, age was an independent risk factor for non-remission, and global assessment scores by patients and physicians showed an age-dependent increase, while counts of tender, swollen and symptomatic joints were comparable among elderly and non-elderly patients.
Global assessment of disease activity was age-dependent and independent of joint counts, and it provides a critical determinant of clinical non-remission.
本研究旨在评估类风湿关节炎（RA）患者在日常临床实践中达到临床缓解的相关因素。
本分析基于 2014 年 5 月至 2015 年 3 月期间在我中心就诊的 304 例 RA 患者的数据。纳入的信息包括：压痛关节、肿胀关节和有症状关节计数、患者和医生的总体评估、功能障碍、实验室和影像学数据以及接受的 RA 治疗。
患者主要为女性（77.6%），中位年龄 71 岁，中位病程 5.8 年。采用简化疾病活动指数（SDAI）评估，临床缓解率为 49.7%。未达到 SDAI 缓解的患者的患者和医生总体评估（/10cm）评分高于达到缓解的患者（中位数：3.2 与 0.3，p<0.0001；中位数：1.8 与 0.3，p<0.0001）。血清 C 反应蛋白值（mg/dL）对 SDAI 的贡献有限（中位数：0.19 与 0.06；p<0.0001），压痛或肿胀关节计数（中位数=0 或 1）也是如此。在与疾病活动无直接关系的因素的多变量分析中，年龄是未缓解的独立危险因素，患者和医生的总体评估评分随年龄增长而增加，而压痛、肿胀和有症状关节的计数在老年和非老年患者中相似。
疾病活动的总体评估与年龄相关，与关节计数无关，是临床未缓解的重要决定因素。
