Prevalence of and Predictive Factors for Sustained Disease-Modifying Antirheumatic Drug-Free Remission in Rheumatoid Arthritis Results From Two Large Early Arthritis Cohorts
Prevalence of and Predictive Factors for Sustained Disease-Modifying Antirheumatic Drug-Free Remission in Rheumatoid Arthritis Results From Two Large Early Arthritis Cohorts
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DOI：
10.1002/art.24661
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发表时间：
2009-08-01
影响因子：
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通讯作者：
van der Helm-van Mil, Annette H. M.
中科院分区：
文献类型：
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作者：
van der Woude, Diane;Young, Adam;van der Helm-van Mil, Annette H. M.
Objective.缓解已成为类风湿关节炎（RA）治疗的一个可达到的目标，特别是自从生物抗风湿治疗的出现。由于对常规治疗达到疾病缓解的患者知之甚少，我们使用了2个大型独立的初始队列研究常规治疗后无疾病缓解抗风湿药物（DMARD）持续缓解的患病率和预测因素。对来自莱顿早期关节炎诊所（EAC）的454例患者和来自英国早期风湿性关节炎研究（ERAS）的895例患者进行了疾病缓解评估，这些患者符合美国风湿病学会1987年修订的RA分类标准，并接受了常规治疗。持续的无DMARD缓解定义为满足以下标准至少1年：1）当前未使用DMARD，2）无关节肿胀，3）患者的风湿病学家分类为无DMARD缓解。采用考克斯回归分析确定预测因素。Leiden EAC中68/454例患者（15.0%）和ERAS中84/895例患者（9.4%）实现了持续无DMARD缓解。在两个队列中，6个因素与持续的无DMARD缓解相关：急性发作、入组前症状持续时间短、不吸烟、基线时影像学损伤小、缺乏IgM类风湿因子（IgM-RF）和缺乏HLA共享表位等位基因。在ERAS中，基线时疾病活动度低也可预测缓解。多变量分析显示症状持续时间和自身抗体（抗环瓜氨酸肽2和IgM-RF）的缺乏是独立的预测因素。在接受常规治疗的RA患者中，持续无DMARD缓解并不罕见。症状持续时间和自身抗体的缺乏与持续的无DMARD缓解相关。
Objective. Remission has become an attainable goal of rheumatoid arthritis (RA) treatment, especially since the advent of biologic antirheumatic therapy. Because little is known about patients who achieve disease remission with conventional treatment, we used 2 large independent inception cohorts to study the prevalence of and predictive factors for disease-modifying antirheumatic drug (DMARD)-free sustained remission after treatment with conventional therapy.Methods. Remission of disease was assessed in 454 patients from the Leiden Early Arthritis Clinic (EAC) and in 895 patients from the British Early Rheumatoid Arthritis Study (ERAS) who fulfilled the American College of Rheumatology 1987 revised criteria for the classification of RA and were treated with conventional therapy. Sustained DMARD-free remission was defined as fulfilling the following criteria for at least 1 year: 1) no current DMARD use, 2) no swollen joints, and 3) classification as DMARD-free remission by the patient's rheumatologist. Predictive factors were identified by Cox regression analysis.Results. Sustained DMARD-free remission was achieved by 68 of 454 patients (15.0%) in the Leiden EAC and by 84 of 895 patients (9.4%) in the ERAS. Six factors were associated with sustained DMARD-free remission in both cohorts: acute onset, short symptom duration before inclusion, not smoking, little radiographic damage at baseline, absence of IgM rheumatoid factor (IgM-RF), and absence of HLA shared epitope alleles. In the ERAS, low disease activity at baseline was also predictive of remission. Multivariate analyses revealed symptom duration and the absence of autoantibodies (anti-cyclic citrullinated peptide 2 and IgM-RF) as independent predictors.Conclusion. Sustained DMARD-free remission in RA patients treated with conventional therapy is not uncommon. Symptom duration at presentation and the absence of autoantibodies are associated with sustained DMARD-free remission.