Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing, 100034, China.
Clin Rheumatol. 2020 Feb;39(2):381-389. doi: 10.1007/s10067-019-04807-8. Epub 2019 Nov 11.
To assess rates of early remission and investigate the concordance across different remission definitions, and to identify predictors of early remission in Chinese patients with rheumatoid arthritis (RA).
For this study, clinical records were retrospectively reviewed for RA patients at rheumatologic clinic in Peking University First Hospital from 2009 to 2018. Disease activity and remission were determined according to DAS28-ESR, CDAI, SDAI, and Boolean criteria. Early remission was defined as time to remission ≤ 6 months. A secondary definition evaluated early remission as ≤ 3 months. Logistic-regression analyses were performed to identify determinants of early remission.
A total of 869 consecutive patients contributing 8640 clinic visits were studied. Early remission rates were respectively 42.0% (DAS28-ESR), 25.0% (CDAI), 29.4% (SDAI), and 26.1% (Boolean). Notably, patients achieving remission within 6 months more frequently attained sustained remission in contrast to those not achieving early remission (68.7-75.1% vs. 31.2-33.1%, p < 0.0001). Further logistic-regression analyses revealed male, early RA, as well as initial hydroxycloroquine treatment were independently associated higher probability of early remission, as demonstrated by nearly all definitions, while a higher baseline disease activity (DAS28-ESR, CDAI, and SDAI) lowered the possibility of early remission in corresponding remission indices. The significant associations of treatment-naïve, serological features with early remission were not confirmed.
Early remission was strongly associated with sustained remission, however. infrequently achievable in real-life practice. Male, early RA, a low baseline disease activity, and initial hydroxycloroquine treatment were stable independent predictors of early remission.Key Points• Early remission was infrequently achievable in real-life practice, especially measured by stringent indices.DAS28-based early remission appears to be the loosest criterion and the remaining three broadly agreed with each other.• Early remission was significantly associated with sustained remission.• Male, early RA, a low baseline disease activity, and initial hydroxycloroquine treatment were positively correlated with early remission.
评估中国类风湿关节炎（RA）患者早期缓解率，并探讨不同缓解定义之间的一致性，同时识别早期缓解的预测因素。
本研究回顾性分析了 2009 年至 2018 年北京大学第一医院风湿免疫科就诊的 RA 患者的临床资料。根据 DAS28-ESR、CDAI、SDAI 和布尔标准判断疾病活动度和缓解情况。将缓解时间≤6 个月定义为早期缓解。另一个次要定义将早期缓解定义为≤3 个月。采用 logistic 回归分析确定早期缓解的决定因素。
共纳入 869 例连续患者，共 8640 次就诊。DAS28-ESR、CDAI、SDAI 和布尔标准的早期缓解率分别为 42.0%、25.0%、29.4%和 26.1%。值得注意的是，与未达到早期缓解的患者相比，在 6 个月内达到缓解的患者更频繁地获得持续缓解（68.7%-75.1% vs. 31.2%-33.1%，p<0.0001）。进一步的 logistic 回归分析显示，男性、早期 RA 以及初始羟氯喹治疗与所有缓解定义的早期缓解概率更高相关，而较高的基线疾病活动度（DAS28-ESR、CDAI 和 SDAI）降低了相应缓解指标中早期缓解的可能性。治疗初治、血清学特征与早期缓解的显著关联未得到证实。
然而，早期缓解与持续缓解密切相关，但在实际临床实践中很少能达到。男性、早期 RA、低基线疾病活动度和初始羟氯喹治疗是早期缓解的稳定独立预测因素。
早期缓解在实际临床实践中很少能达到，尤其是采用严格的标准时。DAS28 为基础的早期缓解似乎是最宽松的标准，其余三个标准基本一致。
早期缓解与持续缓解显著相关。
男性、早期 RA、低基线疾病活动度和初始羟氯喹治疗与早期缓解呈正相关。
