Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis
Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis
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DOI：
10.1093/rheumatology/keh199
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发表时间：
2004-07-01
期刊：
影响因子：
5.5
通讯作者：
Smolen, JS
中科院分区：
文献类型：
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作者：
Nell, VPK;Machold, KP;Smolen, JS
Objective.延迟疾病缓解抗风湿药物（DMARD）治疗是类风湿关节炎（RA）预后不良的主要因素。尽管早期治疗已被证明特别有效，但DMARD引入的最佳时间点仍然存在不确定性。我们想测试在疾病的最初几个月内是否存在治疗的机会窗口。在这项病例对照平行组研究中，20例中位病程为3个月的极早期RA（VERA）患者与20例中位病程为12个月的晚期早期RA（LERA）患者的年龄和性别匹配，直至首次开始DMARD。随访时间为36个月。主要的结果指标是疾病活动性评分（DAS 28）和采用Larsen方法的放射学关节破坏。在DMARD治疗3个月后，我们发现DAS 28的改善显著差异有利于VERA患者。这一趋势在整个研究期间持续存在。研究结束时，VAS 28显示VERA组改善2.8+/-1.5，LERA组改善1.7+/-1.2（P <0.05）。
Objective. Delay of disease-modifying anti-rheumatic drug (DMARD) therapy is a major contributing factor for poor outcome in rheumatoid arthritis (RA). Although early therapy has been shown to be particularly effective, there is still uncertainty about the optimal time point of DMARD introduction. We wanted to test if a therapeutic window of opportunity may exist within the first few months of the disease.Methods. In this case-control parallel-group study, 20 very early RA (VERA) patients with median disease duration of 3 months were age and gender matched to a group of 20 late early RA (LERA) patients with median disease duration of 12 months until first DMARD initiation. Follow-up time was 36 months. Primary outcome measures were the disease activity score (DAS28) and radiological joint destruction using the Larsen method.Results. Already after 3 months of DMARD therapy we found a significant difference of improvement in favour of the VERA patients in the DAS28. This trend continued over the study period. At study end the DAS28 showed an improvement of 2.8+/-1.5 in the VERA vs 1.7+/-1.2 in the LERA group (P-c