University Hospitals Leuven, KU Leuven, Catholic University of Leuven, Leuven, Belgium.
KU Leuven, Catholic University of Leuven, Leuven, Belgium.
Arthritis Care Res (Hoboken). 2019 Dec;71(12):1566-1575. doi: 10.1002/acr.23900.
Treating early, intensively, and to target leads to rapid disease control, preventing joint damage and loss of function in early rheumatoid arthritis (RA). We report the effect of such an approach on patient-reported outcomes and explore the contribution of rapid and persistent disease control to well-being after 1 year of treatment.
This study is part of the Care in Early RA trial, a prospective, 2-year, investigator-initiated, randomized controlled trial rooted in daily practice and implementing the treat-to-target principle. Short Form 36 (SF-36) health survey and Revised Illness Perception Questionnaire (IPQ-R) data were collected prospectively. We defined 4 clinical response profiles based on speed and consistency of the treatment response within the first year, defined as the Disease Activity Score in 28 joints using the C-reactive protein level <2.6. Linear regression analyses including these response profiles and treatment type were constructed to predict the SF-36 dimensions of vitality, social functioning, role emotional, and mental health, and the IPQ-R illness perception subscales of consequences, treatment control, and illness coherence at year 1.
A total of 333 patients were available for the main analyses, including 140 early persistent responders. Variation in each of the psychosocial outcomes at year 1 was explained mostly by baseline values, followed by the clinical response profiles. Patients with an early persistent response reported significantly higher vitality, more positive beliefs about disease consequences and treatment effect. Treatment type did not matter.
Rapid and persistent disease control and not treatment type were associated with favorable patient-reported health and illness perceptions at year 1, but baseline psychosocial variables mattered most. Our data indicate opportunities to broaden the scope of the treat-to-target principle in early RA.
早期积极靶向治疗可迅速控制疾病，防止早期类风湿关节炎（RA）的关节损伤和功能丧失。我们报告了这种方法对患者报告结果的影响，并探讨了快速和持续的疾病控制对治疗 1 年后患者幸福感的贡献。
本研究是早期 RA 治疗研究的一部分，这是一项前瞻性、2 年、研究者发起的、随机对照试验，根植于日常实践并实施靶向治疗原则。前瞻性收集简明 36 健康调查（SF-36）和修订版疾病感知问卷（IPQ-R）数据。我们根据治疗 1 年内治疗反应的速度和一致性定义了 4 种临床反应谱，定义为 C 反应蛋白水平<2.6 的 28 关节疾病活动评分。构建包括这些反应谱和治疗类型的线性回归分析，以预测 SF-36 活力、社会功能、角色情感和心理健康维度，以及 IPQ-R 疾病感知子量表的后果、治疗控制和疾病一致性在第 1 年的情况。
共有 333 名患者可进行主要分析，其中包括 140 名早期持续应答者。第 1 年时每种心理社会结局的变化主要由基线值决定，其次是临床反应谱。早期持续应答者报告的活力更高，对疾病后果和治疗效果的信念更积极。治疗类型并不重要。
快速和持续的疾病控制而不是治疗类型与治疗 1 年后患者报告的健康和疾病感知有关，但基线心理社会变量最重要。我们的数据表明，在早期 RA 中扩大靶向治疗原则的范围具有机会。
