Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Rheumatology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Joint Bone Spine. 2022 Nov;89(6):105418. doi: 10.1016/j.jbspin.2022.105418. Epub 2022 May 27.
Sustained DMARD-free remission (SDFR) is the best possible outcome in RA. It is characterized by sustained absence of clinical arthritis, which is accompanied by resolution of symptoms and restoration of normal physical functioning. Therefore it's the best proxy for cure in RA. The mechanisms underlying SDFR-development are yet unidentified. Hypothetically, there are two possible scenarios. The first hypothesis is based on the concept of regaining immune-tolerance, which implies that RA-patients are similar at diagnosis and that disease-processes during the disease-course shift into a favorable direction, resulting in regaining a state in which arthritis is persistently absent. This could imply that SDFR is theoretically achievable for all RA-patients. The alternative hypothesis is that RA-patients who achieve SDFR are intrinsically different from those who cannot. This would imply that DMARD-cessation could be restricted to a subgroup of RA-patients. Since the 1990s, DMARD-discontinuation and SDFR have been increasingly studied as long-term-outcome in RA. In this review, we describe hitherto results of clinical, genetic, serological, histological and imaging studies and looked for arguments for the first or second hypothesis in both auto-antibody-positive and auto-antibody-negative RA. In auto-antibody-negative RA, SDFR is presumably restricted to a subgroup of patients with high serological-markers of inflammation at diagnosis and a rapid and sustained decrease in inflammation after treatment-start. Identifying these RA-patients could be helpful in realizing personalized-medicine. In auto-antibody-positive RA, only few patients achieve SDFR and no definite conclusions can be drawn, but data could suggest that SDFR-patients might be a subgroup with relatively low inflammation from disease-presentation onwards.
持续的疾病缓解（SDFR）是 RA 患者的最佳治疗结果。其特征为持续无临床关节炎，同时伴随症状缓解和正常身体功能恢复。因此，它是 RA 患者“治愈”的最佳替代指标。目前仍不清楚 SDFR 产生的机制。理论上有两种可能的情况。第一种假设基于重新获得免疫耐受的概念，即 RA 患者在诊断时相似，疾病过程在疾病过程中转向有利方向，从而恢复关节炎持续不存在的状态。这可能意味着 SDFR 在理论上适用于所有 RA 患者。另一种假设是，实现 SDFR 的 RA 患者与不能实现 SDFR 的患者本质上不同。这将意味着 DMARD 停药可能仅限于 RA 患者的亚组。自 20 世纪 90 年代以来，DMARD 停药和 SDFR 作为 RA 的长期治疗结果越来越受到关注。在这篇综述中，我们描述了迄今为止在 RA 中关于临床、遗传、血清学、组织学和影像学研究的结果，并寻找了支持这两种假设的证据，包括自身抗体阳性和自身抗体阴性 RA。在自身抗体阴性 RA 中，SDFR 可能仅限于一组在诊断时具有高炎症血清标志物且治疗开始后炎症迅速和持续下降的患者。识别这些 RA 患者可能有助于实现个体化医学。在自身抗体阳性 RA 中，只有少数患者实现了 SDFR，因此无法得出明确的结论，但数据可能表明 SDFR 患者可能是从疾病开始就具有相对较低炎症的亚组。
