Végh Edit, Gaál János, Géher Pál, Gömöri Edina, Kovács Attila, Kovács László, Nagy Katalin, Posta Edit Feketéné, Tamási László, Tóth Edit, Varga Eszter, Domján Andrea, Szekanecz Zoltán, Szűcs Gabriella
Department of Rheumatology, University of Debrecen, Faculty of Medicine, Nagyerdei str 98, Debrecen, 4032, Hungary.
Department of Rheumatology, University of Debrecen Kenézy Teaching Hospital, Debrecen, Hungary.
BMC Musculoskelet Disord. 2021 Apr 2;22(1):325. doi: 10.1186/s12891-021-04192-x.
The outcome of rheumatoid arthritis (RA) should be determined early. Rapid radiological progression (RRP) is > or = 5 units increase according to the van der Heijde-Sharp score within a year. The risk of RRP can be estimated by a matrix model using non-radiographic indicators, such as C-reactive protein (CRP), rheumatoid factor (RF) and swollen joint count (SJC).
A non-interventional, cross-sectional, retrospective study was conducted in eleven Hungarian arthritis centres. We assessed RRP risk in biologic-naïve RA patients with the prevalence of high RRP risk as primary endpoint. RRP was calculated according to this matrix model. As a secondary endpoint, we compared RRP in methotrexate (MTX) responders vs non-responders.
We analyzed data from 1356 patients. Mean CRP was 17.7 mg/l, RF was 139.3 IU/ml, mean 28-joint disease activity score (DAS28) was 5.00 and mean SJC was 6.56. Altogether 18.2% of patients had high risk (≥40%) of RRP. RA patients with high RRP risk of RRP (n = 247) had significantly lower age compared to those with RRP < 40% (n = 1109). MTX non-response (OR: 16.84), male gender (OR: 1.67), erosions at baseline (OR: 1.50) and ACPA seropositivity (OR: 2.18) were independent predictors of high-risk RRP. Male gender (OR: 5.20), ACPA seropositivity (OR: 4.67) and erosions (OR: 7.98) were independent predictors of high RRP risk in MTX responders.
In this Hungarian study, high RRP risk occurred in 18% of RA patients. These patients differ from others in various parameters. RRP was associated with non-response to MTX.
类风湿关节炎（RA）的病情转归应尽早确定。快速放射学进展（RRP）是指根据范德海伊德 - 夏普评分在一年内增加≥5分。RRP的风险可以通过使用非放射学指标的矩阵模型来估计，如C反应蛋白（CRP）、类风湿因子（RF）和肿胀关节计数（SJC）。
在匈牙利的11个关节炎中心进行了一项非干预性、横断面、回顾性研究。我们将高RRP风险患病率作为主要终点，评估初治生物制剂的RA患者的RRP风险。RRP根据该矩阵模型计算。作为次要终点，我们比较了甲氨蝶呤（MTX）反应者与无反应者的RRP。
我们分析了1356例患者的数据。平均CRP为17.7mg/l，RF为139.3IU/ml，平均28关节疾病活动评分（DAS28）为5.00，平均SJC为6.56。共有18.2%的患者有高RRP风险（≥40%）。RRP风险高的RA患者（n = 247）与RRP<40%的患者（n = 1109）相比，年龄显著更小。MTX无反应（比值比：16.84）、男性（比值比：1.67）、基线时存在侵蚀（比值比：1.50）和抗环瓜氨酸肽抗体（ACPA）血清阳性（比值比：2.18）是高风险RRP的独立预测因素。男性（比值比：5.20）、ACPA血清阳性（比值比：4.67）和侵蚀（比值比：7.98）是MTX反应者中高RRP风险的独立预测因素。
在这项匈牙利研究中，18%的RA患者有高RRP风险。这些患者在各种参数上与其他患者不同。RRP与对MTX无反应相关。
