肥胖是早期类风湿性关节炎临床预后较差及治疗反应不佳的有力预测指标：来自瑞典早期关节炎试验（SWEFOT）的结果
Obesity is a strong predictor of worse clinical outcomes and treatment responses in early rheumatoid arthritis: results from the SWEFOT trial.
作者信息
Levitsky Adrian, Brismar Kerstin, Hafström Ingiäld, Hambardzumyan Karen, Lourdudoss Cecilia, van Vollenhoven Ronald F, Saevarsdottir Saedis
机构信息
Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
出版信息
RMD Open. 2017 Aug 9;3(2):e000458. doi: 10.1136/rmdopen-2017-000458. eCollection 2017.
OBJECTIVES
The aim of this paper was to analyse the impact of obesity, in addition to known predictors, on disease outcome in early rheumatoid arthritis (RA).
METHODS
Body mass index (BMI) was available in 260 patients from the Swedish pharmacotherapy trial (SWEFOT). Differences in disease activity (DAS28), functional impairment (HAQ), pain (Visual Analogue Scale, VAS-pain) and radiographic damage were evaluated over 24 months between BMI categories (obese BMI >30, n=43; overweight BMI=25-29.9, n=74; normal BMI <25, n=143) using non-parametric testing. Predictors of European League Against Rheumatism non-remission (DAS28 ≥2.6) at 24 months of follow-up were evaluated using binary univariate and multivariate logistic regression.
RESULTS
Obesity at baseline was associated with worse continuous-scale clinical outcomes over 24 months (DAS28, HAQ and VAS-pain at last visit: obese vs normal: p<0.001; obese vs overweight: p<0.05). Furthermore, obese patients compared with non-obese patients had significantly greater odds of non-remission at 24 months (adjusted OR (aOR) 5.2; 95% CI 1.8 to 15.2). Other independent predictors were female sex (aOR 2.6; 95% CI 1.1 to 5.8), current smoking (aOR 2.6; 95% CI 1.1 to 6.3) and HAQ (per-unit increase, aOR 1.9; 95% CI 1.1 to 3.4). The pattern was similar among seropositive and seronegative patients; and in the subgroups of methotrexate responders and patients randomised at 3 months to add-on of sulfasalazine+hydroxychloroquine, although not significant with add-on of infliximab. Obesity had no independent association to radiographic progression.
CONCLUSIONS
In this early RA trial reflecting today's standard treatment, obesity, in addition to sex, smoking and functional impairment strongly lowered the chance of attaining good clinical outcomes, including remission, today's treatment goal. This highlights the importance of considering lifestyle modification as one of the cornerstones of RA care.
TRIAL REGISTRATION NUMBER
NCT00764725; Post-results. WHO database at the Karolinska University Hospital: CT20080004.
目的
本文旨在分析肥胖因素以及其他已知预测因素对早期类风湿关节炎（RA）疾病转归的影响。
方法
来自瑞典药物治疗试验（SWEFOT）的260例患者有体重指数（BMI）数据。采用非参数检验，评估24个月内不同BMI类别（肥胖，BMI>30，n = 43；超重，BMI = 25 - 29.9，n = 74；正常，BMI<25，n = 143）之间疾病活动度（DAS28）、功能障碍（HAQ）、疼痛（视觉模拟评分，VAS - 疼痛）和影像学损伤的差异。使用二元单变量和多变量逻辑回归评估随访24个月时欧洲抗风湿病联盟未缓解（DAS28≥2.6）的预测因素。
结果
基线时肥胖与24个月内更差的连续量表临床结局相关（末次随访时的DAS28、HAQ和VAS - 疼痛：肥胖与正常相比：p<0.001；肥胖与超重相比：p<0.05）。此外，与非肥胖患者相比，肥胖患者在24个月时未缓解的几率显著更高（校正比值比（aOR）5.2；95%置信区间1.8至15.2）。其他独立预测因素为女性（aOR 2.6；95%置信区间1.1至5.8）、当前吸烟（aOR 2.6；95%置信区间1.1至6.3）和HAQ（每单位增加，aOR 1.9；95%置信区间1.1至3.4）。血清阳性和血清阴性患者中的模式相似；在甲氨蝶呤反应者亚组以及3个月时随机分组加用柳氮磺吡啶+羟氯喹的患者亚组中也是如此，尽管加用英夫利昔单抗时差异不显著。肥胖与影像学进展无独立关联。
结论
在这项反映当今标准治疗的早期RA试验中，除了性别、吸烟和功能障碍外，肥胖显著降低了获得良好临床结局（包括缓解，当今的治疗目标）的机会。这凸显了将生活方式改变作为RA护理基石之一加以考虑的重要性。
试验注册号
NCT00764725；结果公布后。卡罗林斯卡大学医院的WHO数据库：CT20080004。
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