Edwards Christopher J, Kiely Patrick, Arthanari Subhashini, Kiri Sandeep, Mount Julie, Barry Jane, Mitchell Catherine R, Field Polly, Conaghan Philip G
NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton.
Rheumatology Department, St George's University Hospital NHS Foundation Trust, London, UK.
Rheumatol Adv Pract. 2019 Feb 15;3(1):rkz002. doi: 10.1093/rap/rkz002. eCollection 2019.
Access to biologic DMARDs for RA is often restricted to those with severe disease. This systematic review aimed to identify prognostic factors in patients with moderate disease activity who may be at risk of disease progression and poor clinical outcomes.
MEDLINE, Embase and Cochrane databases were searched (final search 22 September 2017), and data from patients with moderate disease [28-joint DAS (DAS28) >3.2-≤5.1] were included. Studies were evaluated according to the measure(s) of progression/poor outcome used: radiographic, disease activity or other indicators.
The searches identified 274 publications, of which 30 were selected for data extraction. Fourteen studies were prioritized, because they specifically analysed patients with moderate RA. Nine studies reported radiographic progression outcomes for 3241 patients, three studies reported disease activity progression for 1516 patients, and two studies reported other relevant outcomes for 2094 patients. Prognostic factors with consistent evidence for progression/poor outcome prediction were as follows: DAS28 ≥ 4.2, the presence of anti-CCP antibodies, and power Doppler ultrasound score ≥1. Some predictors were specific to either disease activity or radiographic progression.
Several criteria used in standard clinical practice were identified that have the potential to inform the selection of patients with moderate RA who are at greater risk of a poor outcome. A combination of two or more of these factors might enhance their predictive potential. Further work is required to derive clinical decision rules incorporating these factors.
类风湿关节炎（RA）患者使用生物性改善病情抗风湿药（DMARDs）通常仅限于重症患者。本系统评价旨在确定疾病活动度为中度、可能有疾病进展风险和不良临床结局风险的患者的预后因素。
检索了MEDLINE、Embase和Cochrane数据库（最后检索时间为2017年9月22日），纳入了疾病活动度为中度[28个关节的疾病活动度评分（DAS28）>3.2至≤5.1]患者的数据。根据所使用的进展/不良结局衡量指标（影像学、疾病活动度或其他指标）对研究进行评估。
检索共识别出274篇出版物，其中30篇被选用于数据提取。14项研究被优先考虑，因为它们专门分析了中度RA患者。9项研究报告了3241例患者的影像学进展结局，3项研究报告了1516例患者的疾病活动度进展，2项研究报告了2094例患者的其他相关结局。有一致证据表明可用于预测进展/不良结局的预后因素如下：DAS28≥4.2、抗环瓜氨酸肽（CCP）抗体阳性以及能量多普勒超声评分≥1。一些预测因素特定于疾病活动度或影像学进展。
确定了标准临床实践中使用的几个标准，这些标准有可能为选择预后较差风险较高的中度RA患者提供参考。这些因素中的两个或更多因素的组合可能会增强其预测潜力。需要进一步开展工作以得出纳入这些因素的临床决策规则。
