Möttönen T, Paimela L, Leirisalo-Repo M, Kautiainen H, Ilonen J, Hannonen P
Department of Medicine, Turku University Central Hospital, Finland.
Ann Rheum Dis. 1998 Sep;57(9):533-9. doi: 10.1136/ard.57.9.533.
To investigate the prognostic significance of clinical and genetic markers on the outcome of patients with recent-onset rheumatoid arthritis (RA) treated actively with slow acting antirheumatic drugs (SAARDs).
A total of 142 consecutive patients with early RA (median disease duration of 7 months) were treated according to the "sawtooth" strategy and prospectively followed up for an average of 6.2 years. Several clinical parameters at start as well as genetic markers were related to the functional outcome (ARA Functional class and HAQ disability score) and radiographic joint damage (Larsen's score) at the latest visit.
In logistic regression analysis only Mallya score (including morning stiffness, pain scale, grip strength, Ritchie's articular index, haemoglobin, and erythrocyte sedimentation rate) at baseline, and Mallya score and rheumatoid factor (RF) positivity at one year were found to be of significance with respect to the radiographic outcome of the patients. Furthermore, at the latest visit HAQ score was related to radiographic score. At baseline the mean ages of the DR4 positive patients and the patients with RA associated DR alleles were statistically significantly lower than those without the above mentioned risk factors (44 v 49, p = 0.03 and 41 v 53, p = 0.04, respectively). However, these genetic markers had no prognostic significance on the functional or radiographic outcome of the patients.
High clinical disease activity at baseline and RF positivity especially at one year after the institution of SAARD treatment are the best predictors of poor prognosis in early RA. However, from the clinical point of view, the disease outcome of an individual patient with early RA, cannot be predicted accurately enough by present means.
探讨临床和基因标志物对近期发病的类风湿关节炎（RA）患者采用慢作用抗风湿药物（SAARDs）积极治疗后的预后意义。
总共142例连续的早期RA患者（疾病中位病程7个月）按照“锯齿”策略进行治疗，并前瞻性随访平均6.2年。起始时的几个临床参数以及基因标志物与末次随访时的功能结局（美国风湿病学会功能分级和健康评估问卷残疾评分）和放射学关节损伤（拉森评分）相关。
在逻辑回归分析中，仅发现基线时的马利亚评分（包括晨僵、疼痛量表、握力、里奇关节指数、血红蛋白和红细胞沉降率）以及1年时的马利亚评分和类风湿因子（RF）阳性与患者的放射学结局具有相关性。此外，在末次随访时，健康评估问卷评分与放射学评分相关。基线时，DR4阳性患者和具有RA相关DR等位基因患者的平均年龄在统计学上显著低于无上述危险因素的患者（分别为44岁对49岁，p = 0.03；41岁对53岁，p = 0.04）。然而，这些基因标志物对患者的功能或放射学结局无预后意义。
基线时高临床疾病活动度以及尤其是在SAARD治疗开始1年后的RF阳性是早期RA预后不良的最佳预测指标。然而，从临床角度来看，目前的方法尚不足以准确预测单个早期RA患者的疾病结局。
