Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Chungchungnam-do, Korea.
BMC Musculoskelet Disord. 2019 Sep 11;20(1):420. doi: 10.1186/s12891-019-2773-z.
We aimed to evaluate the prevalence of foot and/or ankle arthritis (FAA) and its impact on clinical indices in patients with rheumatoid arthritis (RA).
This cross-sectional study used data from the Korean College of Rheumatology Biologics & Targeted therapy registry to observe clinical outcomes of patients undergoing biologics therapy and conventional therapy. FAA was defined as ≥1 tender or swollen joint in the ankle and/or 1st-5th metatarsophalangeal (MTP) joints. Disease Activity Score 28 (DAS28), Routine Assessment of Patient Index Data 3 (RAPID3), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) were assessed.
Among 2046 patients, 598 had FAA. The ankle joint was the most commonly involved joint in FAA (tender joint, 71.4%; swollen joint, 59.5%), followed by the third and second MTP joints. Patients with FAA showed higher DAS28, RAPID3, SDAI, and CDAI scores. FAA presence was significantly associated with non-remission as per DAS28-ESR (odds ratio, 3.4; 95% confidence interval, 2.0-5.8), DAS28-CRP (3.6, 2.4-5.3), SDAI (6.3, 2.8-14.6), CDAI (7.6, 2.4-24.3), and RAPID3 (5.6, 2.7-11.5) indices on adjusting for age, sex, disease duration, presence of rheumatoid factor, presence of anti-cyclic citrullinated peptide antibody, lung disease, use of methotrexate, and previous use of biological disease-modifying anti-rheumatic drugs. Patients with FAA were less likely to achieve remission of SDAI (n = 6, 1.0%) and CDAI (n = 3, 0.5%) than that of DAS28-ESR (n = 21, 3.5%), DAS28-CRP (n = 38, 6.4%), and RAPID3 (n = 12, 2.0%).
FAA represents a severe disease activity and is an independent risk factor for non-remission in patients with RA.
本研究旨在评估类风湿关节炎（RA）患者足踝关节炎（FAA）的患病率及其对临床指标的影响。
本横断面研究使用韩国风湿病学会生物制剂和靶向治疗登记处的数据，观察接受生物制剂治疗和常规治疗患者的临床转归。FAA 的定义为踝关节和（或）1 至 5 跖趾关节处≥1 个压痛或肿胀关节。评估疾病活动评分 28（DAS28）、简化疾病活动指数（SDAI）、常规评估患者指数数据 3（RAPID3）和临床疾病活动指数（CDAI）。
在 2046 例患者中，598 例存在 FAA。在 FAA 患者中，踝关节是最常受累的关节（压痛关节 71.4%，肿胀关节 59.5%），其次是第三和第二跖趾关节。FAA 患者的 DAS28、RAPID3、SDAI 和 CDAI 评分较高。FAA 的存在与 DAS28-ESR（比值比，3.4；95%置信区间，2.0-5.8）、DAS28-CRP（3.6，2.4-5.3）、SDAI（6.3，2.8-14.6）、CDAI（7.6，2.4-24.3）和 RAPID3（5.6，2.7-11.5）的缓解不达标显著相关，且校正年龄、性别、疾病持续时间、类风湿因子存在、抗环瓜氨酸肽抗体存在、肺部疾病、甲氨蝶呤使用情况和既往使用生物 DMARD 后。与 DAS28-ESR（缓解率 3.5%，n=21）、DAS28-CRP（缓解率 6.4%，n=38）和 RAPID3（缓解率 2.0%，n=12）相比，FAA 患者更不可能达到 SDAI（缓解率 1.0%，n=6）和 CDAI（缓解率 0.5%，n=3）的缓解。
FAA 代表严重的疾病活动度，是 RA 患者缓解不达标独立的危险因素。
