Kuettel D, Primdahl J, Christensen R, Ørnbjerg L M, Hørslev-Petersen K
a King Christian X's Hospital for Rheumatic Diseases , Graasten , Denmark.
b Institute for Regional Health Research , University of Southern Denmark , Odense , Denmark.
Scand J Rheumatol. 2018 Mar;47(2):87-94. doi: 10.1080/03009742.2017.1329457. Epub 2017 Aug 25.
To investigate the impact of patient-reported flares on radiographic damage and disability in rheumatoid arthritis (RA).
Patients with low-active (Disease Activity Score based on 28-joint count with C-reactive protein < 3.2) RA were followed for 2 years. Based on annual questionnaires about incidence of flares, three 'flare phenotypes' were distinguished: no flares (NF), transient flares (TF), and a mixed category reporting persistent joint complaints (PJC) in at least one year. Baseline and 2 year radiographs of hands and feet were evaluated according to the Sharp/van der Heijde method. Major outcomes were change from baseline in Total Sharp Score (ΔTSS) and functional impairment, expressed by the Health Assessment Questionnaire (ΔHAQ). Their association with flare phenotype was analysed by logistic regression.
The study included 268 RA patients (70% female; 73% immunoglobulin M rheumatoid factor positive), with a median age (interquartile range) of 63 (55-70) years, and 7 (4-13) years' disease duration. Flares were recalled as NF (n = 77), TF (n = 141), and PJC (n = 50). ΔTSS > 0 was observed in 35%, 37%, and 46%, respectively (p = 0.42), but statistically significantly (p = 0.01) more patients progressed in the TF (10%) and PJC (14%) compared to NF (0%), based on the smallest detectable change (> 4.4 ΔTSS unit). ΔHAQ above the minimal clinically important difference (> 0.22) was seen in 13% (NF), 21% (TF), and 40% (PJC) (p = 0.0015), with PJC being associated with statistically significant impairment in function (odds ratio 4.47, 95% confidence interval 1.87-10.69) compared to NF.
In RA patients with low disease activity, the incidence of radiographic progression and functional impairment was higher in patients with flares and persistent complaints, compared to those without flares.
研究患者报告的病情活动发作对类风湿关节炎（RA）影像学损伤和残疾的影响。
对低疾病活动度（基于28个关节计数且C反应蛋白<3.2的疾病活动评分）的RA患者进行了为期2年的随访。根据关于病情活动发作发生率的年度问卷，区分出三种“病情活动发作表型”：无病情活动发作（NF）、短暂病情活动发作（TF）以及在至少一年中报告有持续性关节主诉（PJC）的混合类别。根据Sharp/van der Heijde方法对手部和足部的基线及2年时的X光片进行评估。主要结局指标为总Sharp评分（ΔTSS）相对于基线的变化以及由健康评估问卷（ΔHAQ）表示的功能损害。通过逻辑回归分析它们与病情活动发作表型的关联。
该研究纳入了268例RA患者（70%为女性；73%的免疫球蛋白M类风湿因子呈阳性），中位年龄（四分位间距）为63（55 - 70）岁，病程为7（4 - 13）年。回忆起的病情活动发作情况为NF（n = 77）、TF（n = 141）和PJC（n = 50）。分别有35%、37%和46%的患者观察到ΔTSS>0（p = 0.42），但基于最小可检测变化（>4.4 ΔTSS单位），与NF（0%）相比，TF（10%）和PJC（14%）中病情进展的患者在统计学上显著更多（p = 0.01）。在NF（13%）、TF（21%）和PJC（40%）中观察到ΔHAQ高于最小临床重要差异（>0.22）（p = 0.0015），与NF相比，PJC与功能上的统计学显著损害相关（比值比4.47，95%置信区间1.87 - 10.69）。
在疾病活动度低的RA患者中，与无病情活动发作的患者相比，有病情活动发作和持续性主诉的患者影像学进展和功能损害的发生率更高。
