银屑病关节炎“达标治疗”的主要目标应该是什么？
What Should Be the Primary Target of "Treat to Target" in Psoriatic Arthritis?
机构信息
From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso, Italy.
L.C. Coates, MBChB, MRCP ( UK), PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; E. Lubrano, MD, PhD, Associate Professor of Rheumatology and Consultant Rheumatologist, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F.M. Perrotta, MD, Clinical Research Fellow, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; P. Emery, MA, MD, FRCP, FRCPE, Professor of Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust; P.G. Conaghan, MB BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust; P.S. Helliwell, MA, MD, Senior Lecturer, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust.
出版信息
J Rheumatol. 2019 Jan;46(1):38-42. doi: 10.3899/jrheum.180267. Epub 2018 Sep 15.
OBJECTIVE
Recommendations regarding "treat to target" in psoriatic arthritis (PsA) have stated that the target should be remission or inactive disease. Potential definitions include very low disease activity (VLDA), PsA Disease Activity Score (PASDAS) near remission, Disease Activity Index for PsA (DAPSA) or clinical DAPSA (cDAPSA) remission. Our aim was to investigate the proportion of patients who fulfill these definitions and how much residual active disease remained.
METHODS
This analysis used 2 datasets: first, trial data from the Tight Control of PsA (TICOPA) study, which included 206 patients with recent-onset (< 2 yrs) PsA receiving standard and biological disease-modifying antirheumatic drugs (DMARD); and second, an observational clinical dataset from Italy of patients receiving biological DMARD. Proportions achieving each of the 4 potential targets were calculated in each dataset and comparisons between treatment groups were performed in the TICOPA dataset. Levels of residual disease were established for key clinical domains of PsA.
RESULTS
All measures could differentiate the TICOPA trial treatment groups (p < 0.03). Lower proportions of patients fulfilled the VLDA criteria compared to DAPSA or cDAPSA remission. PASDAS results were different between the cohorts. Residual active disease was low across all definitions although higher levels were seen in DAPSA and cDAPSA compared to VLDA, particularly for psoriasis. In all measures, the proportion with elevated C-reactive protein was similar and low.
CONCLUSION
VLDA appears the most stringent measure. It ensures that significant active arthritis, enthesitis, and psoriasis are not present, in contrast with DAPSA and PASDAS, in which composite scores can "hide" active disease in some domains.
目的
有关银屑病关节炎（PsA）“达标治疗”的建议指出，目标应该是缓解或无疾病活动。潜在的定义包括极低疾病活动（VLDA）、接近缓解的 PASA 疾病活动评分（PASDAS）、PsA 疾病活动指数（DAPSA）或临床 DAPSA（cDAPSA）缓解。我们的目的是调查符合这些定义的患者比例以及仍存在多少残留的活动性疾病。
方法
本分析使用了两个数据集：首先是来自 TICOPA 研究的试验数据，该研究包括 206 例发病时间<2 年的新诊断银屑病关节炎患者，接受标准和生物疾病修饰抗风湿药物（DMARD）治疗；其次是意大利的一个接受生物 DMARD 治疗的观察性临床数据集。在每个数据集中计算了每个潜在目标的患者比例，并在 TICOPA 数据集中比较了治疗组之间的差异。建立了银屑病关节炎关键临床领域的残留疾病水平。
结果
所有措施均可区分 TICOPA 试验治疗组（p<0.03）。与 DAPSA 或 cDAPSA 缓解相比，符合 VLDA 标准的患者比例较低。PASDAS 结果在两个队列之间不同。所有定义中残留的活动性疾病水平较低，但 DAPSA 和 cDAPSA 与 VLDA 相比，尤其是银屑病，残留的活动性疾病水平较高。在所有措施中，C 反应蛋白升高的比例相似且较低。
结论
VLDA 似乎是最严格的措施。与 DAPSA 和 PASDAS 不同，它确保不存在明显的活动性关节炎、附着点炎和银屑病，后两者的综合评分可能会在某些领域“隐藏”活动性疾病。
Zotero 插件