A predictive model for remission and low disease activity in patients with established rheumatoid arthritis receiving TNF blockers
A predictive model for remission and low disease activity in patients with established rheumatoid arthritis receiving TNF blockers
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DOI：
10.1007/s10067-012-2146-6
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发表时间：
2013-05-01
影响因子：
3.4
通讯作者：
Chirieac, Rodica
中科院分区：
文献类型：
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作者：
Pomirleanu, Cristina;Ancuta, Codrina;Chirieac, Rodica
本研究的目的是确定在抗tnf - α治疗12个月后已确诊的类风湿关节炎（RA）缓解或低疾病活动性（LDA）的预测因素。我们对90例连续接受tnf - α抑制剂治疗的活动性RA患者进行了一项前瞻性观察研究。每3个月进行一次基线和标准评估，包括个体参数（临床和生物学）和综合活动评分（28关节疾病活动评分，DAS28）。主要结局指标是基于das28的EULAR反应标准。采用多变量logistic回归分析疾病活动性与若干类风湿性关节炎基线特征之间的关系。根据EULAR-DAS28标准，78.8%的RA被分类为良好应答者，44.4%的RA达到缓解（das28a千分之一货币信号，欧元千分之一2.6），34.4%的RA达到缓解（das28a千分之一货币信号，欧元千分之一3.2）。与缓解可能性增加和LDA相关的参数是初始das28 -红细胞沉降率（千分之一货币符号）(优势比（OR） 3.3, 95%可信区间（CI） 2.03-5.81；OR 1.8, 95% CI 1.09-6.68)，健康评估问卷残疾指数a千分之一货币信号欧元千分之一2 (OR 7.0, 95% CI 1.56-31.91; OR 1.3, 95% CI 1.03-5.79)， c反应蛋白水平a千分之一货币信号20mg /l (OR 1.5, 95% CI 0.29-8.22; OR 0.5, 95% CI0.08-2.97)，类风湿因子a千分之一货币信号20iu /ml (OR 18.9, 95% CI 10.79-38.36；OR 32.9, 95% CI 4.03-269)，抗环果糖化肽抗体a千分之一货币符号40 IU/ml (OR 3.5, 95% CI 0.67-18.19; OR 1.2, 95% CI 1.02-1.59)，同时使用强的松龙（OR 0.2, 95% CI 0.05-0.36; OR 0.2, 95% CI 0.06-0.63），甲氨蝶呤或来氟米特（OR 1.6, 95% CI 1.2-13.53; OR 2.9, 95% CI 1.20-4.36）。在接受tnf - α抑制剂治疗的活动期RA患者中，提出了缓解和LDA的预测矩阵。需要进一步的研究来证实这种基质在特定RA环境中的价值，从而优化抗tnf - α治疗的使用。
The objective of this study was to identify predictors for remission or low disease activity (LDA) in established rheumatoid arthritis (RA) at 12 months of anti-TNF-alpha therapy. We have performed a prospective observational study in 90 consecutive patients with active RA receiving TNF-alpha inhibitors. Baseline and standard assessments were done every 3 months, including individual parameters (clinical and biological) and composite activity scores (28-joint disease activity score, DAS28). The primary outcome measure was DAS28-based EULAR response criteria. The multivariate logistic regression was used to analyze the association between disease activity and several RA baseline characteristics. Of the RA, 78.8 % was classified as good responders based on the EULAR-DAS28 criteria, 44.4 % RA achieving remission (DAS28 a parts per thousand currency signaEuro parts per thousand 2.6) and 34.4 %, LDA (DAS28 a parts per thousand currency signaEuro parts per thousand 3.2). Parameters associated with an increased likelihood of remission and LDA were initial DAS28-erythrocyte sedimentation rate a parts per thousand currency sign7 (odds ratio (OR) 3.3, 95 % confidence interval (CI) 2.03-5.81; OR 1.8, 95 % CI 1.09-6.68), Health Assessment Questionnaire Disability Index a parts per thousand currency signaEuro parts per thousand 2 (OR 7.0, 95 % CI 1.56-31.91; OR 1.3, 95 % CI 1.03-5.79), C-reactive protein level a parts per thousand currency sign20 mg/l (OR 1.5, 95 % CI 0.29-8.22; OR 0.5, 95 % CI0.08-2.97), rheumatoid factor a parts per thousand currency sign20 IU/ml (OR 18.9, 95 % CI 10.79-38.36; OR 32.9, 95 % CI 4.03-269), anti-cyclic citrullinated peptide antibodies a parts per thousand currency sign40 IU/ml (OR 3.5, 95 % CI 0.67-18.19; OR 1.2, 95 % CI 1.02-1.59), concurrent prednisolone (OR 0.2, 95 % CI 0.05-0.36; OR 0.2, 95 % CI 0.06-0.63), methotrexate or leflunomide (OR 1.6, 95 % CI 1.2-13.53; OR 2.9, 95 % CI 1.20-4.36). A predictive matrix for remission and LDA in established active RA patients receiving TNF-alpha inhibitors was proposed. Further studies are necessary to confirm the value of such matrix in particular RA settings, leading to optimization of the use of anti-TNF-alpha therapy.