APHP, Centre de Pharmacoépidémiologie (Cephepi), Département de Biostatistique Santé Publique et Information Médicale, CIC 1421, Hôpital Pitié Salpêtrière, Paris, France.
INSERM, UMR 1123, ECEVE, CIC 1421, Paris, France.
Rheumatology (Oxford). 2018 Sep 1;57(9):1563-1573. doi: 10.1093/rheumatology/key122.
Several authors have tried to predict the risk of radiographic progression in RA according to baseline characteristics, considering exposure to treatment only as a binary variable (Treated: Yes/No). This study aims to model the risk of 5-year radiographic progression taking into account both baseline characteristics and the cumulative time-varying exposure to corticosteroids or DMARDs.
The study population consisted of 403 patients of the Etude et Suivi des Polyarthrites Indifférenciées Récentes cohort meeting the 1987 ACR or 2010 ACR/EULAR criteria for RA at inclusion and having complete radiographic data at baseline and 5 years. Radiographic progression was defined at 5 years as a significant increase of the Sharp/van der Heidje score (smallest detectable difference ⩾5). The best logistic regression model was selected from the following: model including only clinico-biological baseline characteristics; model considering baseline characteristics and treatments as binary variables; and model considering baseline characteristics and treatments as weighted cumulative exposure variables.
Radiographic progression occurred in 143 (35.5%) patients. The best model combined anti-citrullinated peptide antibody positivity, ESR, swollen joint count >14 and erosion score at baseline, as well as corticosteroids, MTX/LEF (MTX or LEF) and biologic DMARDs (bDMARDs) as weighted cumulative exposure variables. Recent cumulative exposure to high doses of corticosteroids (⩽ 3months) was significantly associated with the risk of 5-year radiographic progression and a significant protective association was highlighted for a 36-month exposure to bDMARDs.
Corticosteroids and bDMARDs play an important role in radiographic progression. Accounting for treatment class and intensity of exposure is a major concern in predictive models of radiographic progression in RA patients.
一些作者试图根据基线特征预测 RA 的放射学进展风险，仅将治疗暴露视为二分类变量（治疗：是/否）。本研究旨在建立模型，考虑基线特征和累积时间变化的皮质类固醇或 DMARD 暴露，以预测 5 年放射学进展风险。
研究人群包括 403 名符合 1987 年 ACR 或 2010 年 ACR/EULAR 标准的近期未分化多关节炎研究和随访队列患者，在纳入时符合 RA 标准，且基线和 5 年时具有完整的放射学数据。5 年内放射学进展定义为 Sharp/van der Heidje 评分显著增加（最小可检测差异 ⩾5）。从以下最佳逻辑回归模型中选择最佳模型：仅包含临床生物学基线特征的模型；考虑基线特征和治疗的二分类变量的模型；以及考虑基线特征和治疗的加权累积暴露变量的模型。
143 名（35.5%）患者发生放射学进展。最佳模型结合抗瓜氨酸肽抗体阳性、ESR、肿胀关节计数>14 和基线侵蚀评分，以及皮质类固醇、MTX/LEF（MTX 或 LEF）和生物 DMARDs（bDMARDs）作为加权累积暴露变量。最近累积暴露于高剂量皮质类固醇（⩽3 个月）与 5 年放射学进展风险显著相关，暴露于 bDMARDs 36 个月与显著保护相关。
皮质类固醇和 bDMARDs 在放射学进展中起重要作用。在 RA 患者放射学进展预测模型中，考虑治疗类别和暴露强度是一个主要关注点。
