Deng Yafang, Qiao Lin, Li Hongbin, Yu Chen, Jin Shangyi, Wang Jing, Zou Qinghua, Wu Lijun, Duan Xinwang, Xu Jian, Mo Hanyou, Jiang Zhenyu, Jiang Nan, Wang Yanhong, Zeng Xiaofeng, Li Mengtao, Wang Qian, Tian Xinping
School of Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
Int J Rheum Dis. 2025 Jan;28(1):e70066. doi: 10.1111/1756-185X.70066.
The continuous update of international guidelines and enhanced availability of biological disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) have made a significant impact on the diagnosis and treatment of early rheumatoid arthritis (ERA). This study aims to systematically evaluate the current treatment strategies and outcomes within a large-scale cohort of patients with ERA.
Data from the Chinese Registry of Rheumatoid Arthritis (CREDIT), a large multicenter Chinese registry of RA, were collected to analyze temporal trends in clinical profiles, therapeutic strategies, and treatment outcomes among patients with ERA.
From November 2016 to October 2023, A total of 2722 patients with follow-up information for 6 months were included. The use of methotrexate (MTX) increased annually and has become the predominant DMARD as the initial treatment. Following initial therapy, 1059 (38.9%) patients achieved the therapeutic target of low disease activity and remission. Age ≥ 50 years (adjusted OR 0.70 [95% CI 0.59-0.83]; p < 0.001), high baseline disease activity (adjusted OR 0.48 [95% CI 0.41-0.57]; p < 0.001), csDMARD monotherapy other than MTX (adjusted OR 0.55 [95% CI 0.41-0.73]; p < 0.001), and the use of b/tsDMARDs without a csDMARD combination (adjusted OR 0.57 [95% CI 0.36-0.87]; p = 0.011) were associated with lower target attainment rates. For patients who did not achieve the treatment target after initial therapy, the use of b/tsDMARDs increased after 2020, although the extent of therapeutic escalation remained suboptimal.
Treatment of patients with ERA in China has become more standardized. Adherence to guideline-directed therapeutic regimens has emerged as a significant determinant of therapeutic target achievement. The increased prevalence of b/tsDMARDs would benefit more patients in ameliorating the disease.
国际指南的不断更新以及生物改善病情抗风湿药（bDMARDs）和靶向合成改善病情抗风湿药（tsDMARDs）可及性的提高，对早期类风湿关节炎（ERA）的诊断和治疗产生了重大影响。本研究旨在系统评估大规模ERA患者队列中的当前治疗策略和结局。
收集来自中国类风湿关节炎注册研究（CREDIT，一项大型多中心中国RA注册研究）的数据，以分析ERA患者的临床特征、治疗策略和治疗结局的时间趋势。
2016年11月至2023年10月，共纳入2722例有6个月随访信息的患者。甲氨蝶呤（MTX）的使用量逐年增加，已成为初始治疗的主要改善病情抗风湿药。初始治疗后，1059例（38.9%）患者达到低疾病活动度和缓解的治疗目标。年龄≥50岁（调整后OR 0.70[95%CI 0.59-0.83]；p<0.001）、基线疾病活动度高（调整后OR 0.48[95%CI 0.41-0.57]；p<0.001）、非MTX的传统合成改善病情抗风湿药单药治疗（调整后OR 0.55[95%CI 0.41-0.73]；p<0.001）以及使用b/tsDMARDs但未联合传统合成改善病情抗风湿药（调整后OR 0.57[95%CI 0.36-0.87]；p=0.011）与较低的目标达成率相关。对于初始治疗后未达到治疗目标的患者，2020年后b/tsDMARDs的使用增加，尽管治疗升级程度仍不理想。
中国ERA患者的治疗已变得更加规范。坚持指南指导的治疗方案已成为治疗目标达成的重要决定因素。b/tsDMARDs患病率的增加将使更多患者在改善疾病方面受益。
