Rheumatology Centre, Toulouse University Hospital, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Team PEPSS "Pharmacologie En Population cohorteS Et biobanqueS, Purpan Teaching Hospital, University of Toulouse 3, 1 Place du Dr Baylac, 31059, Toulouse, Cedex 9, France.
Inserm, Centre d'Epidémiologie Et de Recherche en Santé Des Populations, UMR1295, Inserm, Toulouse, France.
Arthritis Res Ther. 2023 Oct 20;25(1):207. doi: 10.1186/s13075-023-03176-7.
To compare the 10-year structural and functional prognosis between patients in sustained remission versus patients in sustained low disease activity (LDA) in early rheumatoid arthritis (RA).
We included 256 patients from the ESPOIR cohort who fulfilled the 2010 ACR/EULAR criteria for RA and who were in sustained remission using the Simple Disease Activity Index (SDAI) score (n = 48), in sustained LDA (n = 139) or in sustained moderate to high disease activity (MDA or HDA, n = 69) over 10 years. The mTSSs progression over 10 years and the 10-year HAQ-DI scores were compared between the 3 groups. A longitudinal latent process mixed model was used to assess the independent effect of SDAI status over time on 10-year mTSS progression and HAQ-DI at 10 years.
Patients in sustained remission group were younger, had lower baseline HAQ-DI and mTSS scores and were less exposed to glucocorticoids, methotrexate or biologic disease-modifying anti-rheumatic drugs over 10 years. Patients in sustained remission had lower 10-year structural progression (variation of mTSS in the remission group: 4.06 (± 4.75) versus 14.59 (± 19.76) in the LDA group and 21.04 (± 24.08), p < 0.001 in the MDA or HDA groups) and lower 10-year HAQ-DI scores (10-year HAQ-DI in the remission group: 0.14 (± 0.33) versus 0.53 (± 0.49) in the LDA group and 1.20 (± 0.62) in the MDA or HDA groups, p < 0.001). The incidence of serious adverse events over 10 years was low, about 3.34/100 patient years, without any difference between the three groups.
RA patients in sustained SDAI remission have better long-term structural and functional outcomes in comparison to patients in sustained LDA.
比较早期类风湿关节炎（RA）患者持续缓解与持续低疾病活动（LDA）患者的 10 年结构和功能预后。
我们纳入了 ESPOIR 队列中的 256 名符合 2010 年 ACR/EULAR RA 标准且使用简单疾病活动指数（SDAI）评分持续缓解（n=48）、持续 LDA（n=139）或持续中重度疾病活动（MDA 或 HDA，n=69）超过 10 年的患者。比较三组患者 10 年 mTSS 进展情况和 10 年 HAQ-DI 评分。采用纵向潜在过程混合模型评估 SDAI 状态随时间对 10 年 mTSS 进展和 10 年 HAQ-DI 的独立影响。
持续缓解组患者年龄较小，基线时 HAQ-DI 和 mTSS 评分较低，10 年内接受糖皮质激素、甲氨蝶呤或生物 DMARD 治疗的比例较低。与 LDA 组相比，缓解组患者 10 年结构进展程度较低（缓解组 mTSS 变化：4.06（±4.75）与 LDA 组 14.59（±19.76）和 MDA 或 HDA 组 21.04（±24.08），p<0.001），10 年 HAQ-DI 评分也较低（缓解组 10 年 HAQ-DI：0.14（±0.33）与 LDA 组 0.53（±0.49）和 MDA 或 HDA 组 1.20（±0.62），p<0.001）。10 年内严重不良事件的发生率较低，约为 3.34/100 患者年，三组之间无差异。
与持续 LDA 患者相比，持续 SDAI 缓解的 RA 患者具有更好的长期结构和功能预后。
