Aramaki Toshiyuki, Ueki Yukitaka, Kojima Kanako, Kurushima Shota, Tsuji Yoshika, Kawachi Natsumi, Iwamoto Naoki, Ichinose Kunihiro, Terada Kaoru, Eguchi Katsumi, Kawakami Atsushi
Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo, Japan.
Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Mod Rheumatol. 2020 Jan;30(1):50-57. doi: 10.1080/14397595.2018.1553265. Epub 2019 Jan 3.
: To investigate predictors of inadequate response to first conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) including methotrexate (MTX) in untreated rheumatoid arthritis (RA) patients in daily clinical practice.: Inadequate response to MTX or other csDMARDs was defined as being not low disease activity at 12 months in more than 3 of 4 composite measures, and discontinuation or start of biologic DMARDs. The association between baseline factors and csDMARDs-IR was assessed by univariate and multivariate logistic regression analyses.: Four hundred and eleven and 146 patients were started on MTX and other csDMARDs, respectively; 218 patients were responsive to MTX, with a response rate of 47.0%. Tender joint count (TJC, ≥6 in 28joints, odds ratio [OR] = 1.67, 95% confidence interval [CI] 1.06-2.64) and CRP (≥1.0 mg/dL, OR = 1.72, 95%CI: 1.10-2.70) at baseline were identified as predictors on multivariate logistic regression analysis. TJC (OR = 3.60, 95%CI: 1.29-10.00) was the factor identified as a predictor of the development of other csDMARDs-IR.: In this observational study, patients with untreated RA at risk of inadequate response to MTX included those with a higher TJC and higher CRP, while a higher TJC was the only independent predictor of an inadequate response to csDMARDs other than MTX.
在日常临床实践中，调查初治类风湿关节炎（RA）患者对包括甲氨蝶呤（MTX）在内的一线传统合成改善病情抗风湿药（csDMARDs）反应不足的预测因素。对MTX或其他csDMARDs反应不足的定义为，在4项综合指标中的3项以上指标中，12个月时疾病活动度未降低，以及停用或开始使用生物DMARDs。通过单因素和多因素逻辑回归分析评估基线因素与csDMARDs反应不佳（IR）之间的关联。分别有411例和146例患者开始使用MTX和其他csDMARDs；218例患者对MTX有反应，反应率为47.0%。多因素逻辑回归分析确定基线时压痛关节计数（TJC，28个关节中≥6个，比值比[OR]=1.67，95%置信区间[CI]1.06-2.64）和CRP（≥1.0mg/dL，OR=1.72，95%CI：1.10-2.70）为预测因素。TJC（OR=3.60，95%CI：1.29-10.00）是被确定为其他csDMARDs-IR发生的预测因素。在这项观察性研究中，初治RA患者中对MTX反应不足风险较高的患者包括TJC较高和CRP较高的患者，而较高的TJC是对MTX以外的csDMARDs反应不足的唯一独立预测因素。
