Early suppression of disease activity is essential for maintenance of work capacity in patients with recent-onset rheumatoid arthritis -: Five-year experience from the FIN-RACo trial
Early suppression of disease activity is essential for maintenance of work capacity in patients with recent-onset rheumatoid arthritis -: Five-year experience from the FIN-RACo trial
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DOI：
10.1002/art.20716
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发表时间：
2005-01-01
影响因子：
--
通讯作者：
Leirisalo-Repo, M
中科院分区：
文献类型：
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作者：
Puolakka, K;Kautiainen, H;Leirisalo-Repo, M
Objective.探讨早期活动性类风湿关节炎（RA）患者早期治疗反应对维持工作能力的影响。在芬兰的风湿性关节炎联合治疗试验中，195例近期发作的RA患者随机接受2年的疾病缓解抗风湿药物（DMARD）与泼尼松龙的联合治疗或单一DMARD与或不与泼尼松龙的联合治疗。根据美国流变学学会（ACR）标准评价治疗反应。随访5年后，计算162例患者的病假和RA相关的永久性工作残疾的累积天数，这些患者在基线时可用于积极的工作。在6个月时评估的159例患者中，29例临床缓解，66例达到ACR 50缓解但未缓解，29例达到ACR 20缓解但未达到ACR 50缓解，35例未达到ACR 20缓解。在这4组中，从6个月到60个月随访期间，每患者-年的中位工作残疾天数分别为0（四分位距[IQR] 0-3）、4（IQR 0-131）、16（IQR 0-170）和352（16-365）（P < 0.001）。配对多重比较显示，除ACR 50和ACR 20组外，所有组之间的差异均有统计学意义。12个月时，30名患者缓解。在5年的随访中，44例在6个月或12个月时缓解的患者中无一人成为永久性工作残疾，相比之下，ACR 50组有15例（23%），ACR 20组有6例（21%），6个月时无ACR 20缓解的19例（56%）。迅速诱导缓解转化为维持工作能力。在6个月时，ACR 50的反应在未来生产力方面并不比ACR 20的反应更好，而未能达到ACR 20的反应则有很高的工作残疾风险。
Objective. To explore the impact of an early treatment response on maintenance of work capacity in patients with early, active rheumatoid arthritis (RA).Methods. In the Finnish Rheumatoid Arthritis Combination Therapy trial, 195 patients with recent-onset RA were randomized to receive either a combination of disease-modifying antirheumatic drugs (DMARDs) with prednisolone or a single DMARD with or without prednisolone for 2 years. Treatment responses were evaluated according to the American College of Rheumatology (ACR) criteria. After a 5-year followup, the cumulative number of days of sick leave and RA-related permanent work disability was calculated for each of the 162 patients who were available for the active work force at baseline.Results. Of the 159 patients assessed at 6 months, 29 were in clinical remission, 66 achieved an ACR50 response but not remission, 29 achieved an ACR20 response but not an ACR50 response, and 35 failed to achieve an ACR20 response. In these 4 groups, the median numbers of work disability days per patient-year from 6 months through 60 months of followup were 0 (interquartile range [IQR] 0-3), 4 (IQR 0-131), 16 (IQR 0-170), and 352 (16-365), respectively (P < 0.001). Pairwise multiple comparisons showed a statistically significant difference between all groups except the ACR50 and ACR20 groups. At 12 months, 30 patients were in remission. None of the 44 patients in remission at 6 or 12 months became permanently work disabled over the 5-year followup, as compared with 15 patients in the ACR50 group (23%), 6 in the ACR20 group (21%), and 19 without an ACR20 response at 6 months (56%).Conclusion. Prompt induction of remission translates into maintenance of work capacity. At 6 months, an ACR50 response is no better than an ACR20 response with regard to future productivity, while failure to achieve an ACR20 response carries a high risk for work disability.