类风湿关节炎患者的累积疾病活动监测可预测持续缓解、发作和治疗升级。

Cumulative patient-based disease activity monitoring in rheumatoid arthritis - predicts sustained remission, flare and treatment escalation.

机构信息

Department of Medicine, Queen Elizabeth Hospital, Hong Kong.

Institute of Infection and Immunity, Arthritis Research UK CREATE Centre and Welsh Arthritis Research Network (WARN), Cardiff University School of Medicine, Cardiff, United Kingdom.

出版信息

Semin Arthritis Rheum. 2020 Aug;50(4):749-758. doi: 10.1016/j.semarthrit.2020.03.010. Epub 2020 May 21.

DOI:10.1016/j.semarthrit.2020.03.010

PMID:32531504

Abstract

OBJECTIVE

Patient-based Disease Activity Score 2 (PDAS2) had been developed for RA patients to self-assess and record disease activity in between clinic visits. This study explored the clinical utility of time-integrated cumulative PDAS2 (cPDAS2) on predicting sustained remission or low disease activity state (LDAS), flare and treatment escalation.

METHODS

We recruited 100 patients to record PDAS2 at home fortnightly between two consecutive clinic visits. Rheumatologists adjusted treatment according to disease activity recorded during clinic consultation while blinded to home PDAS2 scores. cPDAS2 calculated from the area-under-curve of all PDAS2 scores were compared with disease activities at both visits. cPDAS2 and ΔcPDAS2 (change from PDAS2 at the first visit) were tested to determine their ability to predict ACR/EULAR remission, SDAI flare-up (from remission/LDAS to moderate/high disease activity) and treatment escalation. Optimal cut-points were determined by Receiver Operator Characteristic curve.

RESULTS

Mean age of the patients was 59 years, mean RA duration 14 years, 90% were female, 71% seropositive and 64% in remission/LDAS. The home PDAS2 completion rate was 92%. PDAS2 scores were done 7.5 times every 15 days over a 16-week follow-up (all medians). The sensitivity of cPDAS2 in predicting Boolean/SDAI remission at two visits, DAS28, SDAI and CDAI remission or LDAS were 93%, 84%, 73% and 80% respectively. cPDAS2 ≥ 0.29 predicted flare (P = 0.04), with specificity 79% and negative predicting value (NPV) 88%. Rheumatologists' decision to escalate treatment was predicted by (cPDAS2 ≥ 4.33 and ΔcPDAS2 ≥ 0.059) (P = 0.007) with specificity 88% and NPV 89%, and (cPDAS2 ≥ 4.33 or ΔcPDAS2 ≥ 0.059) (P = 0.02) with both sensitivity and NPV 100%.

CONCLUSION

PDAS2 monitoring at home is feasible. cPDAS2 is useful to predict flare and treatment escalation.

摘要

目的

患者为基础的疾病活动评分 2 （PDAS2）已被开发用于 RA 患者在就诊之间自我评估和记录疾病活动。本研究探讨了时间积分累积 PDAS2（cPDAS2）预测持续缓解或低疾病活动状态（LDAS）、发作和治疗升级的临床实用性。

方法

我们招募了 100 名患者，在两次连续就诊之间每两周在家中记录 PDAS2。风湿病医生根据就诊期间记录的疾病活动调整治疗，同时对家庭 PDAS2 评分不知情。通过所有 PDAS2 评分的曲线下面积计算 cPDAS2，并将其与两次就诊时的疾病活动进行比较。测试 cPDAS2 和ΔcPDAS2（从第一次就诊时 PDAS2 的变化）的能力，以确定其预测 ACR/EULAR 缓解、SDAI 发作（从缓解/低疾病活动状态到中度/高度疾病活动）和治疗升级的能力。通过接收者操作特征曲线确定最佳临界点。

结果

患者的平均年龄为 59 岁，平均 RA 病程为 14 年，90%为女性，71%为血清阳性，64%处于缓解/低疾病活动状态。家庭 PDAS2 完成率为 92%。在 16 周的随访中，每 15 天进行一次 PDAS2 评分，共进行了 7.5 次（所有中位数）。cPDAS2 在预测两次就诊时的布尔值/SDAI 缓解、DAS28、SDAI 和 CDAI 缓解或 LDAS 的敏感性分别为 93%、84%、73%和 80%。cPDAS2≥0.29 预测发作（P=0.04），特异性为 79%，阴性预测值（NPV）为 88%。风湿病医生决定升级治疗被（cPDAS2≥4.33 和ΔcPDAS2≥0.059）（P=0.007）预测，特异性为 88%，NPV 为 89%，（cPDAS2≥4.33 或ΔcPDAS2≥0.059）（P=0.02）具有敏感性和 NPV 均为 100%。