Remission in Early Rheumatoid Arthritis: Predicting Treatment Response
Remission in Early Rheumatoid Arthritis: Predicting Treatment Response
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DOI：
10.3899/jrheum.110169
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发表时间：
2012-03-01
影响因子：
3.9
通讯作者：
Scott, David L.
中科院分区：
文献类型：
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作者：
Ma, Margaret H. Y.;Ibrahim, Fowzia;Scott, David L.
目标。优化治疗策略以诱导缓解需要了解预测缓解的初始特征。目前还没有合适的模型。我们的目标是利用早期类风湿关节炎（RA）缓解的预测因子建立一个缓解评分。我们使用来自英国随机对照试验的数据集来评估常规联合治疗的强化治疗，以建立24个月缓解的预测模型。我们研究了378名患者，他们接受了24个月的治疗。我们的模型使用来自英国观察队列（早期RA网络，ERAN）的数据进行了验证。对194名患者进行了24个月的随访。缓解定义为28关节疾病活动评分< 2.6。Logistic回归模型用于估计缓解和潜在基线预测因子之间的关联。多因素logistic回归分析显示，年龄、性别和压痛关节计数（TJC）与24个月的缓解独立相关。使用试验数据开发的多变量缓解评分正确分类了80%的患者。这些发现在ERAN中得到了重复。缓解评分具有高特异性（98%）但低敏感性（13%）。结合试验和ERAN的数据，我们还开发了一个简化的缓解评分，显示TJC为5或更低的年轻男性最有可能实现24个月的缓解。TJC高的老年妇女缓解的可能性最小。类风湿因子、类风湿结节和影像学损伤不能预测缓解。可以使用基于年龄、性别和TJC的评分来预测缓解。该评分与临床试验和常规实践设置相关。（首次发布2012年1月15日；journal Rheumatol 2012:39:47 -5; doi: 10.3899/ jrheumat. 110169）
Objective. Optimizing therapeutic strategies to induce remission requires an understanding of the initial features predicting remission. Currently no suitable model exists. We aim to develop a remission score using predictors of remission in early rheumatoid arthritis (RA).Methods. We used a dataset from a UK randomized controlled trial that evaluated intensive treatment with conventional combination therapy, to develop a predictive model for 24-month remission. We studied 378 patients in the trial who received 24 months' treatment. Our model was validated using data from a UK observational cohort (Early RA Network, ERAN). A group of 194 patients was followed for 24 months. Remission was defined as 28-joint Disease Activity Score < 2.6. Logistic regression models were used to estimate the associations between remission and potential baseline predictors.Results. Multivariate logistic regression analyses showed age, sex, and tender joint count (TJC) were independently associated with 24-month remission. The multivariate remission score developed using the trial data correctly classified 80% of patients. These findings were replicated using ERAN. The remission score has high specificity (98%) but low sensitivity (13%). Combining data from the trial and ERAN, we also developed a simplified remission score that showed that younger men with a TJC of 5 or lower were most likely to achieve 24-month remission. Remission was least likely in older women with high TJC. Rheumatoid factor, rheumatoid nodules, and radiographic damage did not predict remission.Conclusion. Remission can be predicted using a score based on age, sex, and TJC. The score is relevant in clinical trial and routine practice settings. (First Release Jan 15 2012; J Rheumatol 2012:39:470-5; doi: 10.3899/jrheum.110169)