Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China.
Clin Exp Rheumatol. 2018 Sep-Oct;36(5):820-828. Epub 2018 Feb 28.
To investigate the trends in the activity of rheumatoid arthritis (RA) over the past 8 years and evaluate the value of treat-to target (T2T) strategy in daily practice.
All the medical records of RA patients from 2009 to 2016 were retrospectively reviewed. Disease activity scores at obtained visits were measured by DAS28-CRP, DAS28-ESR, SDAI and CDAI. To display trends over years, both mean and time-adjusted methods were applied in calculation of annual disease activity and remission rate. Disease activity and remission rate were also compared before and after the year 2011 when application of T2T strategy was initiated in our centre. Furthermore, a sub-cohort study including T2T and non-T2T period groups was conducted with outcome of cumulative percentage of remission and time to achieve first remission during the first year follow-up.
In total, 1,001 patients with 6,944 clinical visits were included. Over an eight-year period, significant improvements were witnessed in disease activity and remission rate, measured by all four indices (p<0.0001). More patients achieved lower disease activity and higher remission rates after T2T adherence in 2011 compared to those in the years 2009 and 2010 (p<0.0001). Moreover, sub-cohort study revealed that more patients (49.3-73.2% vs. 19.1-34.5%, OR=2.4-3.0) achieved remission with a shorter median time compared with the non-T2T period group (p<0.0001), particularly in DAS28-CRP (21 vs. >52 weeks), DAS28-ESR (37 vs. >52 weeks).
Over the past 8 years, the RA activity has substantially decreased and T2T strategy was directly attributable to the favourable changes in clinical practice.
研究过去 8 年来类风湿关节炎（RA）的活动趋势，并评估达标治疗（T2T）策略在日常实践中的价值。
回顾了 2009 年至 2016 年所有 RA 患者的病历。通过 DAS28-CRP、DAS28-ESR、SDAI 和 CDAI 测量就诊时的疾病活动评分。为了显示多年来的趋势，在计算年度疾病活动度和缓解率时，既采用平均值方法，也采用时间调整方法。还比较了在 2011 年我们中心开始应用 T2T 策略前后的疾病活动度和缓解率。此外，还进行了一项亚队列研究，包括 T2T 和非 T2T 时期的组，其结果是第一年随访时达到缓解的累积百分比和达到首次缓解的时间。
共纳入 1001 例患者，6944 次就诊。在八年期间，所有四个指标（p<0.0001）的疾病活动度和缓解率均有显著改善。与 2009 年和 2010 年相比，2011 年 T2T 依从性后，更多患者达到较低的疾病活动度和更高的缓解率（p<0.0001）。此外，亚队列研究显示，与非 T2T 时期组相比，更多患者（49.3%-73.2% vs. 19.1%-34.5%，OR=2.4-3.0）达到缓解，中位时间更短（p<0.0001），尤其是在 DAS28-CRP（21 周 vs. >52 周）和 DAS28-ESR（37 周 vs. >52 周）。
过去 8 年来，RA 活动显著减少，T2T 策略直接导致临床实践的有利变化。
