Prognostic factors in a large cohort of patients with early undifferentiated inflammatory arthritis after application of a structured management protocol
Prognostic factors in a large cohort of patients with early undifferentiated inflammatory arthritis after application of a structured management protocol
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DOI：
10.1002/art.11269
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发表时间：
2003-11-01
影响因子：
--
通讯作者：
Emery, P
中科院分区：
文献类型：
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作者：
Quinn, MA;Green, MJ;Emery, P
Objective.手部炎性关节炎是一种常见的临床表现，其结局各不相同。不符合公认关节炎分类标准的患者被描述为患有未分化的炎性关节炎，对此没有公认的治疗算法。本研究评估了未分化手部关节炎患者使用治疗算法后的临床结果，并评估了这些患者的预后特征。方法。根据临床表现和对治疗的反应，采用务实的治疗方法对100例手部未分化关节炎患者进行了评估。使用以下标准的逐步治疗方案：1）非甾体类抗炎药（NSAID），2）通过肌内或关节内注射给予单剂量皮质类固醇，3）缓解疾病的抗风湿药（DMARD）。排除具有特定风湿病诊断的患者。主要结果是12个月时滑膜炎的持续性。78%的患者接受NSAID治疗，72%接受皮质类固醇治疗，30%接受DMARD治疗。在12个月时有滑膜炎的患者中，基线时类风湿因子（RF）血清阳性、关节肿胀和滑膜炎的患病率高于无持续性滑膜炎的患者。Logistic回归分析显示，基线检查是随后DMARD使用的不良预测因子，最佳预测因子是12周时滑膜炎的持续性。14例患者发生风湿性关节炎（RA）。Logistic回归分析显示，RA的显著预测因子是RF血清阳性和基线时疼痛关节计数。在12周内滑膜炎消退的患者均未发生随后需要DMARD治疗的持续性滑膜炎。只有13%的患者进入缓解期。滑膜炎的早期消退与良好的恢复相关。手部未分化关节炎不是良性疾病，30%的患者在12个月内接受DMARD治疗，缓解率低。12周时的临床评估结果是未来治疗的单一最佳预测因素。这项研究提供了背景数据，用于确定未来的治疗干预措施。
Objective. Inflammatory arthritis of the hands is a frequent clinical presentation with a variable outcome. Patients not satisfying the classification criteria for recognized arthritides are described as having undifferentiated inflammatory arthritis, for which there are no accepted therapeutic algorithms. This study assessed the clinical outcome of patients with undifferentiated arthritis of the hands after use of a treatment algorithm, and evaluated the prognostic features in these patients.Methods. One hundred consecutive patients with undifferentiated arthritis of the hands were assessed following use of a pragmatic treatment algorithm that was based on clinical presentation and response to treatment. The following standard step-up treatment protocol was used: 1) nonsteroidal antiinflammatory drugs (NSAIDs), 2) a single dose of corticosteroid administered by either intramuscular or intraarticular injection, and 3) disease-modifying antirheumatic drugs (DMARDs). Patients with specific rheumatologic diagnoses were excluded. The primary outcome was persistence of synovitis at 12 months.Results. Seventy-eight percent of patients received NSAIDs, 72% received corticosteroids, and 30% received DMARD therapy. Among patients who had synovitis at 12 months, the prevalence of rheumatoid factor (RF) seropositivity, swollen joints, and synovitis at baseline was greater than in those without persistent synovitis. Logistic regression analysis showed baseline investigations to be poor predictors of subsequent DMARD use, with the best predictor being persistence of synovitis at 12 weeks. Rheumatoid arthritis (RA) developed in 14 patients. Logistic regression analysis showed that significant predictors of RA were RF seropositivity and the painful joint count at baseline. No patient who experienced resolution of synovitis by 12 weeks had persistent synovitis that subsequently required DMARD therapy. Only 13% of patients entered remission. Early resolution of synovitis was associated with an excellent prognosis.Conclusion. Undifferentiated arthritis of the hands is not a benign condition, with 30% of patients receiving DMARD therapy by 12 months and low remission rates. Results of the clinical assessment at 12 weeks is the single best predictor of future therapy. This study provides background data for use in determining future therapeutic interventions.