Hetland M L, Østergaard M, Stengaard-Pedersen K, Junker P, Ejbjerg B, Jacobsen S, Ellingsen T, Lindegaard H, Pødenphant J, Vestergaard A, Jurik A G, Krogh N S, Hørslev-Petersen K
a Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases , Rigshospitalet , Glostrup , Denmark.
b Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.
Scand J Rheumatol. 2019 Jan;48(1):1-8. doi: 10.1080/03009742.2018.1466362. Epub 2018 Aug 13.
To investigate the clinical and radiographic status, and to identify baseline predictors of functional status and erosive progression at 11 years' follow-up of early rheumatoid arthritis (RA) patients.
Patients enrolled in the Danish investigator-initiated randomized controlled CIMESTRA trial, which investigated a 2 year treat-to-target intervention with methotrexate and intra-articular glucocorticoids with or without cyclosporine, were followed up. The 28-joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) score, and total Sharp van der Heijde score (TSS) were assessed at baseline and 11 years. Baseline magnetic resonance imaging (MRI) of unilateral wrists was scored (OMERACT RAMRIS). Multivariable linear regression analyses of baseline variables [TSS, HAQ, DAS28, age, anti-cyclic citrullinated peptide (anti-CCP) status, gender, MRI erosion score, MRI synovitis score, MRI bone marrow oedema score] were performed in 96 patients with HAQ and ∆TSS as dependent variables. Since outcomes were similar in the two treatment arms, data were pooled.
In total, 120 of 160 patients completed 11 years' follow-up. They were 63 (55-72) years old, 68% were in DAS28 remission (≤ 2.4), HAQ was 0.25 (0-0.75), mean ∆TSS was 0.96 ± 1.52 units/year; 53%, 20%, and 27% received conventional treatment, biologics, and no treatment, respectively; and 34% had not progressed radiographically since baseline. Increased DAS28 (p = 0.02) and anti-CCP (p = 0.03) predicted HAQ, whereas anti-CCP (p = 0.03) and MRI bone marrow oedema (p = 0.01) predicted ∆TSS in multivariable analyses.
Early and strict synovitis suppression with methotrexate and intra-articular glucocorticoids led to persistently high remission rates and limited erosive progression at 11 years. In this well-treated cohort, baseline anti-CCP status, DAS28, and MRI bone marrow oedema predicted functional status and/or erosive progression.
调查早期类风湿关节炎（RA）患者的临床和影像学状况，并确定在11年随访中功能状态和侵蚀性进展的基线预测因素。
对参与丹麦研究者发起的随机对照CIMESTRA试验的患者进行随访，该试验研究了使用甲氨蝶呤和关节内糖皮质激素进行为期2年的达标治疗干预，联合或不联合环孢素的情况。在基线和11年时评估28个关节疾病活动评分（DAS28）、健康评估问卷（HAQ）评分和夏普总范德海伊德评分（TSS）。对单侧手腕的基线磁共振成像（MRI）进行评分（OMERACT RAMRIS）。以HAQ和∆TSS为因变量，对96例患者的基线变量[TSS、HAQ、DAS28、年龄、抗环瓜氨酸肽（抗CCP）状态、性别、MRI侵蚀评分、MRI滑膜炎评分、MRI骨髓水肿评分]进行多变量线性回归分析。由于两个治疗组的结果相似，因此将数据合并。
160例患者中共有120例完成了11年随访。他们的年龄为63（55 - 72）岁，68%处于DAS28缓解状态（≤2.4），HAQ为0.25（0 - 0.75），平均∆TSS为0.96±1.52单位/年；分别有53%、20%和27%的患者接受传统治疗、生物制剂治疗和未接受治疗；34%的患者自基线以来影像学上未进展。在多变量分析中，DAS28升高（p = 0.02）和抗CCP（p = 0.03）可预测HAQ，而抗CCP（p = 0.03）和MRI骨髓水肿（p = 0.01）可预测∆TSS。
使用甲氨蝶呤和关节内糖皮质激素早期严格抑制滑膜炎可使11年时持续保持高缓解率并限制侵蚀性进展。在这个治疗良好的队列中，基线抗CCP状态、DAS28和MRI骨髓水肿可预测功能状态和/或侵蚀性进展。
