Reduction in long-term disability in patients with rheumatoid arthritis by disease-modifying antirheumatic drug-based treatment strategies
Reduction in long-term disability in patients with rheumatoid arthritis by disease-modifying antirheumatic drug-based treatment strategies
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DOI：
10.1002/art.1780390412
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发表时间：
1996-04-01
影响因子：
--
通讯作者：
Sibley, J
中科院分区：
文献类型：
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作者：
Fries, JF;Williams, CA;Sibley, J
客观的。类风湿性关节炎 (RA) 的治疗策略已经从传统的“金字塔”方法演变为基于早期和持续使用缓解病情抗风湿药物 (DMARD) 的方法，以期改善长期健康结果。然而，很少有数据可以证明这种方法的效果。我们试图直接评估持续使用 DMARD 与长期功能结果之间的关联。方法。我们研究了 2,888 名 RA 患者，他们在 8 个数据库中心进行了长达 20 年（平均 9 年）的前瞻性随访。自变量是导致接受大于或等于 1 种 DMARD（羟氯喹、柳氮磺吡啶、金诺芬、肌注金、D-青霉胺、甲氨蝶呤和/或硫唑嘌呤）治疗的患者比例。因变量是健康评估问卷 (HAQ) 中每个患者最后记录的残疾指数值。结果。增加 DMARD 使用与更好的长期残疾指数值密切相关 (P < 0.0001)。当仅限于受影响更严重（类风湿因子（RF）阳性）患者时，这种关联得到加强。未经调整，100% DMARD 使用和 0% 之间的影响程度差异为 0.53 HAQ 残疾单位（等级 0-3）。相关系数最高可达 0.26。所有疾病持续时间（0-4、5-9、10-14、15-19 和 20 年以上）的效果相似。 “对照”相关性，即通过计算变量来代表患者服用非甾体类抗炎药或泼尼松的时间比例，未能显示出正相关性。多元线性回归模型控制了年龄、病程、性别、RF 阳性、泼尼松治疗方案就诊比例和初始残疾水平，包括患者服用 DMARD 的时间比例 (P < 0.0001)，模型 R(2) 为 0.54。尽管存在逆向选择偏差（即受影响更严重的个体更频繁地接受 DMARD），并且尽管缺乏许多患者病程早期的药物使用数据，但仍获得了这些结果。因此，这些结果很可能是保守的，表明持续使用 DMARD 可将长期残疾减少 30%。结论。这些数据支持持续使用 DMARD 与 RA 长期功能结果改善之间的关联。
Objective. Therapeutic strategies for rheumatoid arthritis (RA) have been evolving from the traditional ''pyramid'' approach toward one based upon early and sustained use of disease-modifying antirheumatic drugs (DMARDs), in the hope of improving long-term health outcomes. However, few data to have been presented to document the effects of this approach. We sought to directly assess associations between consistent DMARD use and long-term functional outcomes.Methods. We studied 2,888 RA patients who were followed up prospectively for up to 20 years (average 9 years) at 8 databank centers. The independent variable was the proportion of patient encounters that resulted in treatment with greater than or equal to 1 DMARD (hydroxychloroquine, sulfasalazine, auranofin, intramuscular gold, D-penicillamine, methotrexate, and/or azathioprine). The dependent variable was each patient's last recorded Disability Index value from the Health Assessment Questionnaire (HAQ).Results. Increased DMARD use was strongly associated with better long-term Disability Index values (P < 0.0001). The association was strengthened when restricted to more seriously affected (rheumatoid factor (RF)-positive) patients. The magnitude of the effect, unadjusted, was a difference of 0.53 HAQ Disability units (scale 0-3) between 100% DMARD use and 0%. Correlation coefficients ranged up to 0.26. Effects were similar for all disease duration periods (0-4, 5-9, 10-14, 15-19, and 20+ years). ''Control'' correlations, with variables computed to represent the proportion of time in which patients were taking either nonsteroidal antiinflammatory drugs or prednisone, failed to show positive associations. A multiple linear regression model, which controlled for age, disease duration, sex, RF positivity, proportion of visits under a prednisone regimen, and initial disability level, included the proportion of time in which patients were taking DMARDs (P < 0.0001), with a model R(2) of 0.54. These results were obtained despite an adverse selection bias in which more severely affected individuals were given DMARDs more frequently, and despite absence of data on drug use early in the disease course of many patients. Thus, these results, which suggest up to a 30% reduction in longterm disability with consistent DMARD use, are most likely conservative.Conclusion. An association between consistent DMARD use and improvement in long-term functional outcomes in RA is supported by these data.