Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China.
Int J Rheum Dis. 2019 Sep;22(9):1670-1678. doi: 10.1111/1756-185X.13651. Epub 2019 Jul 12.
To investigate the prevalence and predictors of sustained remission (SR) in an unselected Chinese rheumatoid arthritis (RA) population.
Medical records of RA patients from 2009 to 2016 were retrospectively reviewed. Clinical remission was defined according to Disease Activity Score in 28 joints using erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and Boolean criteria. Remission persisting for at least 6 months was regarded as SR (6-month SR). Kaplan-Meier method and Cox regression analyses were performed to plot cumulative possibility of achieving 6-month SR and to identify predictors.
Seven hundred and seventy-nine patients contributing 7958 clinic visits were included. During the follow-up period, nearly half of patients achieved 6-month SR according to DAS28-ESR (51.6%), CDAI (45.6%), SDAI (44.0%), as well as Boolean definitions (42.4%). Median time periods to 6-month SR were respectively 20.5, 28.7, 30.6, and 32.9 months based on the above criteria. Specifically, 29.4% to 41.2% of patients achieved 6-month SR at least once in the first year of follow-up, depending on instruments. Multivariate Cox regression indicated that increasing age, longer disease duration, higher baseline disease activity were independently correlated with reduced possibility of 6-month SR assessed by nearly all definitions. Conversely, male, early RA, disease-modifying antirheumatic drug-naïve and lower disease activity scores in remission measured by corresponding criteria positively contributed to SR. Importantly, treat-to-target (T2T) adherence therapy and shorter time to remission were identified as stable determinants of SR across all definitions.
Achieving 6-month SR was not uncommon in daily practice. Male, early RA, treatment-naïve, T2T application, shorter time to remission, and lower disease activity scores in remission increased the occurrence of SR, while increasing age, longer disease duration, and higher baseline disease activity reduced the chance of remission sustainability.
调查未经选择的中国类风湿关节炎（RA）人群中持续缓解（SR）的患病率和预测因素。
回顾性分析 2009 年至 2016 年 RA 患者的病历。根据红细胞沉降率（DAS28-ESR）、临床疾病活动指数（CDAI）、简化疾病活动指数（SDAI）和布尔标准，临床缓解定义为 28 个关节疾病活动评分。至少持续 6 个月的缓解被认为是 SR（6 个月 SR）。采用 Kaplan-Meier 法和 Cox 回归分析绘制累积达到 6 个月 SR 的可能性，并确定预测因素。
779 例患者共 7958 次就诊，纳入研究。在随访期间，根据 DAS28-ESR（51.6%）、CDAI（45.6%）、SDAI（44.0%）和布尔定义（42.4%），近一半的患者达到了 6 个月 SR。达到 6 个月 SR 的中位时间分别为 20.5、28.7、30.6 和 32.9 个月。具体而言，根据不同的标准，在随访的第一年，有 29.4%至 41.2%的患者至少有一次达到 6 个月 SR。多变量 Cox 回归分析表明，年龄增加、病程延长、基线疾病活动度较高与几乎所有定义的 6 个月 SR 可能性降低独立相关。相反，男性、早期 RA、疾病修饰抗风湿药物初治和相应标准下缓解时的较低疾病活动度评分与 SR 呈正相关。重要的是，治疗目标（T2T）治疗依从性和达到缓解的时间较短被确定为所有定义中 SR 的稳定决定因素。
在日常实践中，达到 6 个月 SR 并不罕见。男性、早期 RA、初治、T2T 应用、达到缓解的时间较短和缓解时的较低疾病活动度评分增加了 SR 的发生，而年龄增加、病程延长和基线疾病活动度较高降低了缓解可持续性的机会。
