已处于临床缓解期的类风湿关节炎患者关节损伤进展和严格缓解的预测因素。
Predictors of joint damage progression and stringent remission in patients with established rheumatoid arthritis in clinical remission.
机构信息
Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.
Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark.
出版信息
Rheumatology (Oxford). 2021 Jan 5;60(1):380-391. doi: 10.1093/rheumatology/keaa496.
OBJECTIVES
To study if clinical, radiographic and MRI markers can predict MRI and radiographic damage progression and achievement of stringent remission in patients with established RA in clinical remission followed by a targeted treatment strategy.
METHODS
RA patients (DAS28-CRP <3.2, no swollen joints) receiving conventional synthetic DMARDs were randomized to conventional or MRI-targeted treat-to-target strategies with predefined algorithmic treatment escalations. Potentially predictive baseline variables were tested in multivariate logistic regression analyses.
RESULTS
In the 171 patients included, baseline MRI osteitis independently predicted progression in MRI erosion [odds ratio (OR) 1.13 (95% CI 1.06, 1.22)], joint space narrowing [OR 1.15 (95% CI 1.07, 1.24)] and combined damage [OR 1.23 (95% CI 1.13, 1.37)], while tenosynovitis independently predicted MRI erosion progression [OR 1.13 (95% CI 1.03, 1.25)]. A predictor of radiographic erosion progression was age, while gender predicted progression in joint space narrowing. Following an MRI treat-to-target strategy predicted stringent remission across all remission definitions: Clinical Disease Activity Index remission OR 2.94 (95% CI 1.25, 7.52), Simplified Disease Activity Index remission OR 2.50 (95% CI 1.01, 6.66), ACR/EULAR Boolean remission OR 5.47 (95% CI 2.33, 14.13). Similarly, low tender joint count and low patient visual analogue scale pain and global independently predicted achievement of more stringent remission.
CONCLUSION
Baseline MRI osteitis and tenosynovitis were independent predictors of 2 year MRI damage progression in RA patients in clinical remission, while independent predictors of radiographic damage progression were age and gender. Following an MRI treat-to-target strategy, low scores of patient-reported outcomes and low tender joint count predicted achievement of stringent remission.
TRIAL REGISTRATION
ClinicalTrials.gov (https://clinicaltrials.gov), NCT01656278.
目的
研究在临床缓解后接受靶向治疗策略的已确诊 RA 患者中，临床、影像学和 MRI 标志物是否可预测 MRI 和影像学损伤进展以及达到严格缓解。
方法
RA 患者（DAS28-CRP＜3.2，无肿胀关节）接受常规合成 DMARDs 治疗，随机分为常规或 MRI 靶向治疗至目标策略，采用预设算法治疗升级。在多变量逻辑回归分析中测试潜在的预测性基线变量。
结果
在纳入的 171 例患者中，基线 MRI 骨炎独立预测 MRI 侵蚀进展[比值比（OR）1.13（95%置信区间 1.06，1.22）]、关节间隙狭窄[OR 1.15（95% CI 1.07，1.24）]和联合损伤[OR 1.23（95% CI 1.13，1.37）]，而腱鞘炎独立预测 MRI 侵蚀进展[OR 1.13（95% CI 1.03，1.25）]。影像学侵蚀进展的预测因素是年龄，而性别预测关节间隙狭窄的进展。采用 MRI 治疗至目标策略预测所有缓解定义的严格缓解：临床疾病活动指数缓解 OR 2.94（95%置信区间 1.25，7.52）、简化疾病活动指数缓解 OR 2.50（95%置信区间 1.01，6.66）、ACR/EULAR 布尔缓解 OR 5.47（95%置信区间 2.33，14.13）。同样，低压痛关节计数和低患者视觉模拟量表疼痛和总体评分独立预测更严格的缓解。
结论
基线 MRI 骨炎和腱鞘炎是 RA 患者临床缓解后 2 年 MRI 损伤进展的独立预测因素，而影像学损伤进展的独立预测因素是年龄和性别。采用 MRI 治疗至目标策略后，患者报告结局评分低和压痛关节计数低预测达到严格缓解。
试验注册
ClinicalTrials.gov（https://clinicaltrials.gov），NCT01656278。
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