幼年特发性关节炎患者开始使用疾病修正抗风湿药物的时间与青年期无药物缓解的可能性。
Time of Disease-Modifying Antirheumatic Drug Start in Juvenile Idiopathic Arthritis and the Likelihood of a Drug-Free Remission in Young Adulthood.
机构信息
German Rheumatism Research Center and Charité-University Medicine Berlin, Berlin, Germany.
Asklepios Clinic Sankt Augustin GmbH, Sankt Augustin, and University Hospital of Cologne, Cologne, Germany.
出版信息
Arthritis Care Res (Hoboken). 2019 Apr;71(4):471-481. doi: 10.1002/acr.23709.
OBJECTIVE
To study juvenile idiopathic arthritis (JIA) long-term outcomes in relation to the time of initiation of biologic disease-modifying antirheumatic drug (bDMARD).
METHODS
Outcomes of JIA patients prospectively followed by the Biologika in der Kinderrheumatologie (BiKeR) and Juvenile Arthritis Methotrexate/Biologics Long-Term Observation (JuMBO) registers were analyzed with regard to drug-free remission and inactive disease, functional status and quality of life, and surgery. To analyze the influence of early bDMARD therapy on outcomes, patients were assigned to 3 groups based on the time from symptom onset to bDMARD start (G1: ≤2 years, G2: >2 to ≤5 years, and G3: >5 years). Propensity score-adjusted outcome differences were analyzed by multinomial logistic regression analyses among the groups.
RESULTS
A total of 701 JIA patients were observed for mean ± SD 9.1 ± 3.7 years. At the last follow-up (disease duration mean ± SD 14.3 ± 6.1 years), 11.7% of patients were in drug-free remission, and 40.0% had inactive disease. More than half of the patients reported no functional limitation, while 5% had undergone arthroplasty, and 3% had eye surgery. At the 10-year time point, patients in G1 (n = 108) were significantly more likely to be in drug-free remission than those patients who began treatment later (G2, n = 199; G3, n = 259), with 18.5%, 10.1%, and 4.9%, respectively. Patients in G1 had significantly lower disease activity (clinical Juvenile Arthritis Disease Activity Score in 10 joints = 4.9), a better overall well-being (18.2% patient global assessment score = 0), and higher functional status (59.2% Health Assessment Questionnaire score = 0), compared to patients in G3 (7.1, 8.4%, and 43.7%, respectively). G1 patients required arthroplasty significantly less frequently than G3 patients and had significantly lower disease activity over time than patients in both G2 and G3.
CONCLUSION
Early DMARD treatment is associated with better disease control and outcomes, which supports the concept of a "window of opportunity" for JIA.
目的
研究生物改善病情抗风湿药物（bDMARD）治疗开始时间与青少年特发性关节炎（JIA）长期结局之间的关系。
方法
对 Biologika in der Kinderrheumatologie（BiKeR）和 Juvenile Arthritis Methotrexate/Biologics Long-Term Observation（JuMBO）登记处前瞻性随访的 JIA 患者的结局进行分析，评估无药物缓解和疾病不活动、功能状态和生活质量以及手术情况。为了分析早期 bDMARD 治疗对结局的影响，根据症状发作至 bDMARD 开始的时间将患者分为 3 组（G1：≤2 年，G2：>2 至≤5 年，G3：>5 年）。通过多变量逻辑回归分析比较组间的倾向评分调整后结局差异。
结果
共观察 701 例 JIA 患者，平均随访时间为 9.1±3.7 年。末次随访（病程平均±标准差 14.3±6.1 年）时，11.7%的患者处于无药物缓解状态，40.0%的患者疾病不活动。超过一半的患者报告无功能受限，5%的患者接受了关节置换术，3%的患者接受了眼部手术。在 10 年时间点，G1 组（n=108）患者明显比开始治疗较晚的患者（G2 组，n=199；G3 组，n=259）更有可能处于无药物缓解状态，分别为 18.5%、10.1%和 4.9%。与 G3 组相比，G1 组患者疾病活动度明显较低（10 个关节临床幼年特发性关节炎疾病活动评分=4.9），整体健康状况较好（18.2%患者总体评估评分=0），功能状态较高（59.2%健康评估问卷评分=0）。G1 组患者接受关节置换术的频率明显低于 G3 组，且随时间推移疾病活动度明显低于 G2 组和 G3 组。
结论
早期 DMARD 治疗与更好的疾病控制和结局相关，这支持了 JIA 的“机会之窗”概念。
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