Thompson P W, Kirwan J R, Barnes C G
Br J Rheumatol. 1985 May;24(2):167-75. doi: 10.1093/rheumatology/24.2.167.
Reappraisal of disease-modifying antirheumatoid drug (DMARD) therapy in rheumatoid arthritis (RA) has raised the possibility that the risks of treatment outweigh the benefits. To provide more information a retrospective survey of the case-notes of 325 patients with RA was performed. The case-notes were randomly selected from the 2320 RA patients indexed in one department. Improvement was defined by the contemporary written notes of the managing physician. Analysis employed the life-table technique. A total of 247 case-notes could be adequately analysed: 154 patients had received one or more DMARDs constituting 251 drug-patient exposures. Improvement followed drug-patient exposure in 57% of cases after a delay of between one and seven months. Nine per cent occurred within one month and 22% within two months. Of those patients withdrawn from treatment after less than two months, the 'early withdrawal' group, 25% subsequently improved without further DMARD therapy. The probability of still receiving a specific DMARD 8 months, 24 months and 36 months after the start of treatment was 50%, 25% and 10%, respectively. The majority of withdrawals resulted from adverse reactions. There was no evidence for a relationship between patient responses to sequential DMARDs.
对类风湿关节炎（RA）中改善病情抗风湿药物（DMARD）治疗的重新评估引发了一种可能性，即治疗风险可能超过益处。为了提供更多信息，对325例RA患者的病历进行了回顾性调查。这些病历是从一个科室索引的2320例RA患者中随机选取的。改善情况由主治医生当时的书面记录来定义。分析采用寿命表技术。总共247份病历能够得到充分分析：154例患者接受了一种或多种DMARD，构成251次药物 - 患者暴露。在1至7个月的延迟后，57%的病例在药物 - 患者暴露后出现改善。9%在1个月内出现改善，22%在2个月内出现改善。在治疗少于2个月后退出治疗的患者（“早期退出”组）中，25%随后在未接受进一步DMARD治疗的情况下病情改善。治疗开始后8个月、24个月和36个月仍在接受特定DMARD治疗的概率分别为50%、25%和10%。大多数退出是由不良反应导致的。没有证据表明患者对序贯DMARD的反应之间存在关联。
