Division of Rheumatology, Department of Internal Medicine, Seoul Veterans Hospital, Seoul, Korea.
Department of Information Medicine, Asan Medical Center, Seoul, Korea.
Int J Rheum Dis. 2020 Aug;23(8):1076-1081. doi: 10.1111/1756-185X.13888. Epub 2020 Jul 6.
We investigated the disease flare rate in patients with rheumatoid arthritis (RA) who achieved low disease activity following long-term methotrexate (MTX) treatment and the factors related to flare.
This retrospective longitudinal cohort study included patients with RA and low disease activity who were exposed to MTX for >10 years. Disease flare was defined as an increase in Disease Activity Score of 28 joints (DAS28) of >1.2 within 6 months of discontinuation of MTX. Logistic regression analysis was performed to identify the factors associated with flare.
In total, 97 patients with RA were included in the study. The mean baseline DAS28 was 1.96 ± 0.56. The median cumulative MTX dose was 11.7 g; the median duration of exposure to MTX was 19 years. Following MTX discontinuation, flare occurred in 43 (44.3%) patients; the median time to flare was 99 (28-168) days. According to univariate logistic regression analysis, C-reactive protein, erythrocyte sedimentation rate (ESR) at discontinuation, the average ESR in the 6 months before discontinuation of MTX, a weekly dose of MTX before discontinuation, and use of other conventional synthetic disease-modifying antirheumatic drugs were associated with a higher risk of disease flare. In multivariable analysis, a weekly dose of MTX before discontinuation (odds ratio 1.014; 95% CI 1.014-1.342; P = .031) was significantly associated with flare risk.
Among patients with RA who achieved low disease activity with long-term treatment with MTX, more than half remained flare free after MTX discontinuation. A higher MTX dose before discontinuation was associated with a high flare risk.
我们研究了长期接受甲氨蝶呤（MTX）治疗后达到低疾病活动度的类风湿关节炎（RA）患者的疾病复发率，以及与复发相关的因素。
本回顾性纵向队列研究纳入了接受 MTX 治疗>10 年且处于低疾病活动度的 RA 患者。疾病复发定义为在停止 MTX 治疗后 6 个月内 DAS28 增加>1.2。采用 logistic 回归分析确定与复发相关的因素。
共纳入 97 例 RA 患者。基线 DAS28 的平均水平为 1.96±0.56。MTX 的累积剂量中位数为 11.7g；MTX 的中位暴露时间为 19 年。停止 MTX 治疗后，43（44.3%）例患者出现复发；复发的中位时间为 99（28-168）天。根据单因素 logistic 回归分析，停药时 C 反应蛋白、红细胞沉降率（ESR）、停药前 6 个月内的 ESR 平均值、停药前每周 MTX 剂量和使用其他常规合成改善病情抗风湿药与疾病复发风险增加相关。多变量分析显示，停药前每周 MTX 剂量（比值比 1.014；95%CI 1.014-1.342；P=.031）与复发风险显著相关。
在长期接受 MTX 治疗达到低疾病活动度的 RA 患者中，超过一半的患者在停止 MTX 治疗后仍保持无复发状态。停药前较高的 MTX 剂量与较高的复发风险相关。
