Disease flares in rheumatoid arthritis are associated with joint damage progression and disability: 10-year results from the BeSt study.
Disease flares in rheumatoid arthritis are associated with joint damage progression and disability: 10-year results from the BeSt study.
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DOI：
10.1186/s13075-015-0730-2
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发表时间：
2015-08-31
影响因子：
4.9
通讯作者：
Allaart CF
中科院分区：
文献类型：
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作者：
Markusse IM;Dirven L;Gerards AH;van Groenendael JH;Ronday HK;Kerstens PJ;Lems WF;Huizinga TW;Allaart CF
类风湿性关节炎患者的症状有时会自行消退。靶向治疗可能会导致过度治疗。我们的目的是确定接受目标治疗的患者的耀斑患病率，并评估耀斑与患者报告的结果和放射学进展之间的关联。在 BeSt 研究中，508 名患者接受了为期 10 年的目标治疗。在初步治疗调整达到疾病活动评分≤2.4后，根据三种定义，从随访第二年开始定义耀斑。第一个定义是疾病活动评分>2.4，且增加≥0.6，无论之前的疾病活动评分如何。其他定义将在手稿中描述。每次就诊的耀斑患病率为 4-11%； 67% 的患者在 9 年的治疗期间出现 ≥1 次发作（每位患者每年中位数为 0 次）。发作期间，健康评估问卷中功能能力下降，平均差异为 0.25（p < 0.001），而患者在视觉模拟量表上对疾病活动、疼痛和晨僵的评估增加≥20 mm 的比值比（95% 置信区间）分别为 8.5 (7.3–9.8)、8.4 (7.2–9.7) 和 5.6 (4.8–6.6)。分别与没有 耀斑。与没有耀斑的一年相比，有耀斑的一年中放射学进展的优势比为 1.7 (1.1–2.8)。患者经历的耀斑次数越多，第 10 年的健康评估问卷越高 (p < 0.001)，并且从基线到第 10 年的放射学进展越多 (p = 0.005)。无论是在发作期间还是长期，发作与患者对疾病活动、疼痛和晨僵、功能恶化以及具有剂量反应效应的放射学进展的评估同时增加相关。这表明在发作期间加强治疗超过了可能的过度治疗的风险。荷兰试验登记处 NTR262（2005 年 9 月 7 日）和 NTR265（2005 年 9 月 8 日）。
Flares in patients with rheumatoid arthritis are suggested to sometimes spontaneously resolve. Targeted therapy could then entail possible overtreatment. We aimed to determine the flare prevalence in patients who are treated-to-target and to evaluate associations between flares and patient-reported outcomes and radiographic progression. In the BeSt study, 508 patients were treated-to-target for 10 years. After initial treatment adjustments to achieve disease activity score ≤2.4, a flare was defined from the second year of follow-up onwards, according to three definitions. The first definition is a disease activity score >2.4 with an increase of ≥0.6 regardless of the previous disease activity score. The other definitions will be described in the manuscript. The flare prevalence was 4–11 % per visit; 67 % of the patients experienced ≥1 flare during 9 years of treatment (median 0 per patient per year). During a flare, functional ability decreased with a mean difference of 0.25 in health assessment questionnaire (p < 0.001), and the odds ratios (95 % confidence intervals) for an increase in patients’ assessment of disease activity, pain and morning stiffness of ≥20 mm on a visual analogue scale were 8.5 (7.3–9.8), 8.4 (7.2–9.7) and 5.6 (4.8–6.6), respectively, compared to the absence of a flare. The odds ratio for radiographic progression was 1.7 (1.1–2.8) in a year with a flare compared to a year without a flare. The more flares a patient experienced, the higher the health assessment questionnaire at year 10 (p < 0.001) and the more radiographic progression from baseline to year 10 (p = 0.005). Flares were associated with concurrent increase in patient’s assessment of disease activity, pain and morning stiffness, functional deterioration and development of radiographic progression with a dose–response-effect, both during the flare and long term. This suggests that intensifying treatment during a flare outweighs the risk of possible overtreatment. Dutch trial registry NTR262 (7 September 2005) and NTR265 (8 September 2005).