Current smoking status is a strong predictor of radiographic progression in early rheumatoid arthritis: results from the SWEFOT trial
Current smoking status is a strong predictor of radiographic progression in early rheumatoid arthritis: results from the SWEFOT trial
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目前的吸烟状况是早期类风湿性关节炎放射学进展的有力预测因素：SWEFOT 试验的结果
DOI：
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发表时间：
2014
影响因子：
27.4
通讯作者：
R. V. van Vollenhoven
中科院分区：
文献类型：
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作者：
S. Saevarsdottir;H. Rezaei;P. Geborek;I. Petersson;S. Ernestam;K. Albertsson;K. Forslind;R. V. van Vollenhoven
目的研究早期类风湿关节炎（RA）试验1年后影像学进展的临床预测因素。方法在SWEFOT试验人群中，疾病改善抗风湿药物（DMARD） naïve RA患者开始使用甲氨蝶呤；3个月应答者（DAS28 <3.2）继续（n=147），无应答者随机加入磺胺氮嗪+羟氯喹组（n=130）或英夫利昔单抗组（n=128）。x线片采用Sharp-van der Hejde评分（SHS）法评分，影像学进展定义为1年后增加≥5。使用多变量逻辑回归测试放射学进展的潜在基线预测因子，并对潜在混杂因素进行调整。结果在基线和随访时，311例患者中有79例放射学进展。以下基线参数是1年放射学进展的独立预测因素：基线侵蚀（校正OR=2.29, 95% CI 1.24至4.24）、红细胞沉降率（校正OR每1 / 4增加=1.72,95% CI 1.12至2.65）和c反应蛋白（校正OR每1 / 4增加=1.52,95% CI 1.03至2.26）。当前吸烟是影像学进展的独立预测因子（调整后OR=2.17, 95% CI 1.06 - 4.45）。在进一步调整治疗策略后，这些结果仍然存在。与所有预测因子相比，包括吸烟状况、侵蚀和c反应蛋白在内的三维矩阵显示，无预测因子的患者的风险梯度为12-63%。类风湿因子(RF)/抗环瓜氨酸肽（anti-CCP）阳性不能显著预测影像学进展，以SHS升高≥5为截止值。在使用截断值bbb1的二次探索性分析中，RF和anti-CCP阳性在未调整的分析中都是显著的预测因子，但在调整后的分析中则不是。使用这个较低的截止值，其他参数也仍然很重要。结论：除了先前描述的预测因素外，我们发现吸烟是早期RA影像学进展的一个强大的独立危险因素。试验注册号NCT00764725。
Objectives To study clinical predictors for radiographic progression after 1 year in an early rheumatoid arthritis (RA) trial. Methods In the SWEFOT trial population, disease modifying antirheumatic drug (DMARD) naïve RA patients started methotrexate; 3-month responders (DAS28 <3.2) continued (n=147), while non-responders were randomised to addition of sulfasalazine+hydroxychloroquine (n=130) or infliximab (n=128). X-rays were scored by the Sharp-van der Hejde score (SHS) method and radiographic progression was defined as a ≥5 increase after 1 year. Potential baseline predictors of radiographic progression were tested using multivariable logistic regression, adjusted for potential confounders. Results 79 of 311 patients with available radiographs at baseline and follow-up had radiographic progression. The following baseline parameters were independent predictors of radiographic progression at 1 year: baseline erosions (adjusted OR=2.29, 95% CI 1.24 to 4.24), erythrocyte sedimentation rate (adjusted OR per tertile increase=1.72, 95% CI 1.12 to 2.65) and C-reactive protein (adjusted OR per tertile increase=1.52, 95% CI 1.03 to 2.26). Current smoking was an independent predictor of radiographic progression (adjusted OR=2.17, 95% CI 1.06 to 4.45). These results remained after further adjustment for treatment strategy. Three-dimensional matrix including current smoking status, erosions and C-reactive protein tertiles showed a 12–63% risk gradient from patients carrying none compared with all predictors. Rheumatoid factor (RF)/anti-cyclic citrullinated peptide (anti-CCP) positivity did not significantly predict radiographic progression using SHS increase ≥5 as cut-off. In a secondary exploratory analysis using cut-off >1, both RF and anti-CCP positivity were significant predictors in the unadjusted, but not the adjusted analyses. The other parameters also remained significant using this lower cut-off. Conclusions In addition to previously described predictors, we identified smoking as a strong independent risk factor for radiographic progression in early RA. Trial registration number NCT00764725.