Influence of disease-modifying therapy on radiographic outcome in inflammatory polyarthritis at five years - Results from a large observational inception study
Influence of disease-modifying therapy on radiographic outcome in inflammatory polyarthritis at five years - Results from a large observational inception study
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DOI：
10.1002/art.10727
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发表时间：
2003-01-01
影响因子：
--
通讯作者：
Silman, AJ
中科院分区：
文献类型：
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作者：
Bukhari, MAS;Wiles, NJ;Silman, AJ
客观的。目的 确定早期使用缓解病情抗风湿药物 (DMARD) 治疗对新发炎症性多关节炎患者 5 年期间减少影像学进展的效果。方法。对 335 名连续患者进行了研究，这些患者在加入基于人群的关节炎登记后 1 年和 5 年获得了配对 X 光片。使用逻辑回归来模拟与 DMARD 开始相关的基线因素的差异。从症状出现到首次使用 DMARD 的时间分为 4 组：未使用 DMARD，12 个月。使用拉森方法对手和脚的射线照片进行评分。拉森评分的进展被评估为根据第一部电影评分调整后的 5 年评分。使用负二项回归来比较 3 个治疗组与未接受 DMARD 的患者的 Larsen 评分进展。然后根据倾向模型对结果进行严重程度调整。结果。接受治疗的患者比未接受治疗的患者有更多的放射学进展。 DMARD 治疗患者与未治疗患者相比的系数（95% 置信区间）如下：1.6 (1.1-2.3)，持续 12 个月。正如预期的那样，接受治疗的患者在基线时患有更严重的疾病。使用倾向评分作为调整疾病严重程度的方法，治疗对结果的影响减弱如下：1.1 (0.8-1.7)，持续 12 个月。这种效应在第 5 年的粗略 Larsen 评分中也可见到。结论。在这项观察性研究中，DMARD 治疗不仅是就诊时病情恶化的标志，也是 5 年放射学状态和放射学进展的标志。在对基线疾病严重程度进行调整后，早期治疗被证明对结果有有益的影响。
Objective. To determine the effect of early treatment with disease-modifying antirheumatic drugs (DMARDs) in reducing radiographic progression over a 5-year period in patients with new-onset inflammatory polyarthritis.Methods. Three hundred thirty-five consecutive patients with paired radiographs obtained I year and 5 years after enrollment in a population-based arthritis register were studied. Logistic regression was used to model differences in baseline factors associated with the start of DMARDs. The time from symptom onset to first use of DMARDs was stratified to represent 4 groups: no DMARD use, 12 months. Radiographs of the hands and feet were scored using the Larsen method. Progression in the Larsen score was evaluated as a 5-year score adjusted for the first film score. Negative binomial regression was-used to compare Larsen score progression for each of the 3 treatment groups with that for patients not receiving DMARDs. Results were then adjusted for severity, based on propensity modeling.Results. Patients who received treatment had more radiographic progression than did patients who were untreated. Coefficients (95% confidence intervals), expressed as a multiple of the Larsen score in DMARD-treated patients compared with untreated patients, were as follows: 1.6 (1.1-2.3) for 12 months. As expected, patients receiving treatment had more severe disease at baseline. Using the propensity score as a method of adjusting for disease severity, the influence of treatment on outcome became attenuated as follows: 1.1 (0.8-1.7) for 12 months. This effect was also seen in the crude Larsen score at year 5.Conclusion. In this observational study, DMARD treatment was a marker not only of worse disease at presentation but also of the radiographic state and radiographic progression at 5 years. After adjustments were made for baseline disease severity, earlier therapy was shown to have a beneficial effect on outcome.