Parisi Simone, Zanetti Anna, Carrara Greta, Scirè Carlo Alberto, Iagnocco Annamaria, Filippou Georgios
Rheumatology Unit, AOU Città Della Salute e della Scienza di Torino, Turin, Italy.
Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
Rheumatology (Oxford). 2023 Apr 3;62(4):1485-1492. doi: 10.1093/rheumatology/keac518.
This study is a sub-analysis from the patient cohort of the STARTER (Sonographic Tenosynovitis Assessment in RheumaToid arthritis patiEnts in Remission) study. The aim was to evaluate differences in ultrasound-detected joint and/or tendon involvement between patients receiving therapies based on a combination of conventional synthetic DMARDs (csDMARDs) and biologic DMARDs (bDMARDs) and those who were treated with either csDMARDs or bDMARDs in monotherapy.
Four hundred and twenty-seven consecutive patients with a diagnosis of RA were recruited between October 2013 and June 2014. They were divided into three subgroups based on their therapy at baseline: patients with bDMARD in monotherapy, patients with csDMARD in monotherapy and patients in combination therapy (csDMARD + bDMARD). At baseline, 6 months and 12 months, a clinical examination (28 joint count) and an ultrasound evaluation were performed in each patient. A score of grey-scale (GS) and power Doppler (PD) synovitis and tenosynovitis was calculated based on the OMERACT scoring systems.
Two hundred and fifty-six patients completed the observation period: 48 patients from the bDMARD group (18.75%), 152 patients from the csDMARD group (59.38%) and 56 patients from csDMARD + bDMARD group (21.88%). The analysis showed that GS tenosynovitis and PD tenosynovitis are better controlled in combination therapy than they are with csDMARD alone (P = 0.025 and P = 0.047, respectively); for PD synovitis, there was a better response in those who were treated with the combination therapy when compared with the patients receiving csDMARD (P = 0.01) or bDMARD (P = 0.02) alone.
The analysis showed a lower prevalence of subclinical inflammatory manifestations detected with ultrasound imaging in those patients treated with the combination therapy than in those in monotherapy.
本研究是STARTER（类风湿关节炎缓解期患者的超声腱鞘炎评估）研究患者队列的一项亚分析。目的是评估接受基于传统合成改善病情抗风湿药（csDMARDs）和生物改善病情抗风湿药（bDMARDs）联合治疗的患者与接受csDMARDs或bDMARDs单药治疗的患者在超声检测到的关节和/或肌腱受累情况上的差异。
2013年10月至2014年6月期间连续招募了427例确诊为类风湿关节炎的患者。根据基线治疗情况将他们分为三个亚组：bDMARDs单药治疗患者、csDMARDs单药治疗患者和联合治疗患者（csDMARD + bDMARD）。在基线、6个月和12个月时，对每位患者进行临床检查（28个关节计数）和超声评估。根据OMERACT评分系统计算灰阶（GS）和能量多普勒（PD）滑膜炎及腱鞘炎评分。
256例患者完成了观察期：bDMARDs组48例（18.75%），csDMARDs组152例（59.38%），csDMARD + bDMARD组56例（21.88%）。分析表明，联合治疗对GS腱鞘炎和PD腱鞘炎的控制优于单独使用csDMARDs（分别为P = 0.025和P = 0.047）；对于PD滑膜炎，联合治疗患者的反应优于单独接受csDMARDs（P = 0.01）或bDMARDs（P = 0.02）治疗的患者。
分析表明，联合治疗患者超声成像检测到的亚临床炎症表现患病率低于单药治疗患者。
