University of Nebraska Medical Center, Omaha, and FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas.
University of Western Ontario, London, Ontario, Canada.
Arthritis Care Res (Hoboken). 2021 Nov;73(11):1606-1616. doi: 10.1002/acr.24369. Epub 2021 Sep 9.
To evaluate the nature and burden of residual disease in rheumatoid arthritis (RA) in patients who meet treatment targets. Second, for those who did not meet targets, to evaluate how much is due to patient symptoms.
Prospective and retrospective studies were searched in Medline, Embase, and Cochrane Library in the English language from January 1, 2008 to April 18, 2018; conference abstracts (from January 2016 to April 2018) and reference lists of relevant studies were also screened.
Of 8,339 records identified, 55 were included in the review; 53 were unique studies, including 10 randomized controlled trials. Of these, 48 reported on patients who achieved low disease activity (LDA) or remission. Studies varied in population, treatment goals, and outcome reporting. The proportions of patients with residual symptoms in these studies varied by the definitions used for LDA or remission and were more often reported in patients with LDA than those in remission. The most commonly reported outcome measures were functional disability (n = 34 studies), tender or swollen joints (n = 18), pain (n = 17), patient global assessment (n = 15), and fatigue (n = 14). However, few studies reported the percentage of patients achieving a specific threshold, which could then be used to easily define the presence of residual symptoms.
Residual symptoms are present in some patients despite their achieving LDA or remission, highlighting an unmet need, especially with respect to improving pain, fatigue, and function. Standardized reporting in future observational studies would facilitate better understanding of this issue in defined RA populations.
评估达到治疗目标的类风湿关节炎（RA）患者的残余疾病的性质和负担。其次，对于那些未达到目标的患者，评估有多少是由于患者的症状所致。
检索了 Medline、Embase 和 Cochrane Library 中 2008 年 1 月 1 日至 2018 年 4 月 18 日的英文前瞻性和回顾性研究；还筛选了会议摘要（2016 年 1 月至 2018 年 4 月）和相关研究的参考文献列表。
在 8339 条记录中，有 55 项研究被纳入综述；其中 53 项是独特的研究，包括 10 项随机对照试验。其中，48 项研究报告了达到低疾病活动（LDA）或缓解的患者情况。这些研究在人群、治疗目标和结果报告方面存在差异。在这些研究中，使用 LDA 或缓解的定义，残余症状患者的比例不同，且在 LDA 患者中比在缓解患者中更为常见。最常报告的结局测量指标是功能障碍（n = 34 项研究）、压痛或肿胀关节（n = 18 项）、疼痛（n = 17 项）、患者总体评估（n = 15 项）和疲劳（n = 14 项）。然而，很少有研究报告达到特定阈值的患者比例，这可以用来简单地定义残余症状的存在。
尽管达到了 LDA 或缓解，但一些患者仍存在残余症状，这突显了一个未满足的需求，特别是在改善疼痛、疲劳和功能方面。在未来的观察性研究中进行标准化报告将有助于更好地理解特定 RA 人群中的这一问题。
