A combination of biochemical markers of cartilage and bone turnover, radiographic damage and body mass index to predict the progression of joint destruction in patients with rheumatoid arthritis treated with disease-modifying anti-rheumatic drugs
A combination of biochemical markers of cartilage and bone turnover, radiographic damage and body mass index to predict the progression of joint destruction in patients with rheumatoid arthritis treated with disease-modifying anti-rheumatic drugs
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DOI：
10.1007/s10165-009-0170-4
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发表时间：
2009-06-01
影响因子：
2.2
通讯作者：
Nishimoto, Norihiro
中科院分区：
文献类型：
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作者：
Hashimoto, Jun;Garnero, Patrick;Nishimoto, Norihiro
本研究的目的是评估生物学、放射学和临床参数对类风湿关节炎（RA）患者接受常规疾病改善抗风湿药物（DMARDs）治疗后影像学关节损伤进展的预测价值。我们分析了145名活动期小于5年的RA患者，这些患者参加了tocilizumab作为常规DMARDs治疗对照组的前瞻性1年随机对照试验（SAMURAI试验）。通过两个独立的盲式x线阅读器读取顺序x线片评估关节损伤的进展，并使用van der Heijde-modified Sharp方法对骨侵蚀和关节间隙狭窄（JSN）进行评分。多因素分析显示，尿中II型胶原c端交联末端肽（U-CTX-II）水平升高、尿中总吡啶啉/总脱氧吡啶啉（U-PYD/DPD）比率升高和基线时较低的体重指数（BMI）与骨质侵蚀进展的高风险独立相关。除了这三个变量外，基线时的JSN评分也与JSN评分和Sharp总分进展风险的增加显著相关。高基线U-CTX-II水平、U-PYD/DPD比值和JSN评分以及低BMI是常规dmard治疗的RA患者影像学上明显关节损伤的独立预测指标。
The aim of this study was to evaluate the predictive value of biological, radiological and clinical parameters for the progression of radiographic joint damage in rheumatoid arthritis (RA) patients treated with conventional disease-modifying anti-rheumatic drugs (DMARDs). We analyzed the 145 patients with active RA for less than 5 years who were participating in the prospective 1-year randomized controlled trial of tocilizumab (SAMURAI trial) as a control arm treated with conventional DMARDs. Progression of joint damage was assessed by sequential radiographs read by two independent blinded X-ray readers and scored for bone erosion and joint space narrowing (JSN) using the van der Heijde-modified Sharp method. Multivariate analysis revealed that increased urinary levels of C-terminal crosslinked telopeptide of type II collagen (U-CTX-II), an increased urinary total pyridinoline/total deoxypyridinoline (U-PYD/DPD) ratio and low body mass index (BMI) at baseline were independently associated with a higher risk for progression of bone erosion. In addition to these three variables, the JSN score at baseline was also significantly associated with an increased risk of progression of the JSN score and total Sharp score. High baseline U-CTX-II levels, U-PYD/DPD ratio and JSN score and a low BMI are independent predictive markers for the radiographically evident joint damage in patients with RA treated with conventional DMARDs.