Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands.
Rheumatology (Oxford). 2021 Aug 2;60(8):3716-3726. doi: 10.1093/rheumatology/keaa845.
To compare patient-reported outcome (PRO) domains between three arthritis phenotypes [undifferentiated arthritis (UA), autoantibody-negative RA (RA-) and autoantibody-positive RA (RA+)] at diagnosis, after 2 years and over time.
All UA (n = 130), RA- (n = 176) and RA+ (n = 331) patients from the tREACH trial, a stratified single-blinded trial with a treat-to-target approach, were used. PRO comparisons between phenotypes at baseline and after 2 years were performed with analysis of variance, while a linear mixed model compared them over time. Effect sizes were weighted against the minimal clinically important differences (MCIDs) for each PRO.
RA- patients had a higher disease burden compared with RA+ and UA. At baseline and after 2 years, RA- patients had more functional impairment and a poorer Physical Component Summary (PCS) compared with the other phenotypes, while they only scored worse for general health and morning stiffness duration at baseline. The MCIDs were exceeded at baseline, except for functional ability between RA+ and UA, while after 2 years only the MCID of the PCS was exceeded by RA- compared with UA and RA. After 2 years the PROs of all phenotypes improved, but PROs measuring functioning were still worse compared with the general population, even when patients had low disease activity.
RA- patients had the highest disease burden of all phenotypes. Although most patients have low disease activity after treatment, all clinical phenotypes still have a similar significant impact on patients' lives, which is mainly physical. Therefore it is important to assess and address PROs in daily practice because of persistent disease burden despite low disease activity.
ISRCTN26791028.
比较三种关节炎表型[未分化关节炎（UA）、抗核抗体阴性类风湿关节炎（RA-）和抗核抗体阳性类风湿关节炎（RA+）]在诊断时、2 年后以及随时间推移的患者报告结局（PRO）。
本研究使用了 TREACH 试验中的所有 UA（n=130）、RA-（n=176）和 RA+（n=331）患者，该试验是一项分层单盲、以达标为治疗策略的试验。采用方差分析比较表型之间在基线和 2 年后的 PRO 差异，线性混合模型比较其随时间的变化。对每个 PRO 的效应大小进行了最小临床重要差异（MCID）加权。
与 RA+和 UA 相比，RA-患者的疾病负担更高。在基线和 2 年后，RA-患者的功能障碍更严重，物理成分综合评分（PCS）更差，而在其他表型中，仅在基线时一般健康和晨僵时间的评分更差。除了 RA+和 UA 之间的功能能力外，在基线时 MCID 都得到了超过，而在 2 年后，只有 RA-与 UA 和 RA 相比，PCS 的 MCID 得到了超过。在 2 年后，所有表型的 PRO 都得到了改善，但与一般人群相比，衡量功能的 PRO 仍较差，即使患者的疾病活动度较低。
在所有表型中，RA-患者的疾病负担最高。尽管治疗后大多数患者的疾病活动度较低，但所有临床表型对患者的生活仍有类似的显著影响，主要是身体上的。因此，在日常实践中评估和解决 PRO 是很重要的，因为尽管疾病活动度较低，但仍存在持续的疾病负担。
ISRCTN26791028。
