Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate.
Remaining Pain in Early Rheumatoid Arthritis Patients Treated With Methotrexate.
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DOI：
10.1002/acr.22790
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发表时间：
2016-08
影响因子：
4.7
通讯作者：
Lampa, Jon
中科院分区：
文献类型：
--
作者：
Altawil, Reem;Saevarsdottir, Saedis;Wedren, Sara;Alfredsson, Lars;Klareskog, Lars;Lampa, Jon
旨在调查早期类风湿性关节炎 (RA) 在使用甲氨蝶呤作为唯一的疾病缓解抗风湿药物治疗 3 个月后剩余疼痛的频率，特别关注临床反应良好的患者。研究基础是向基于人群的早期 RA 队列报告的病例，该队列拥有瑞典风湿病质量登记册的后续数据 (n = 1,241)。欧洲抗风湿病联盟 (EULAR) 28 个关节的疾病活动评分反应标准用于评估治疗的临床反应为良好、中等和无反应。主要终点是 3 个月随访时的剩余疼痛，定义为 100 毫米视觉模拟量表 (VAS) 上疼痛 >20 毫米。尽管 EULAR 随访时反应良好，但剩余疼痛与较高的基线残疾相关，使用健康评估问卷（调整后的比值比 [OR] 2.2 [95% 置信区间 (95% CI) 1.4-3.4] 每单位增加），以及较少的基线炎症，使用红细胞沉降率（调整后的 OR 0.81 [95% CI 0.70-0.93] 每 10 毫米）增加）。尽管炎症活动度较低（定义为 C 反应蛋白水平<10），但在随访中仍检测到剩余疼痛存在类似的关联。在整个队列中，有 19% 的患者在治疗期间观察到 VAS 疼痛增加，EULAR 缓解组中的频率为 9%（良好缓解）、15%（中等缓解）和 45%（无缓解）。这些结果符合这样的假设：早期 RA 患者的一个亚群表现出非炎症介导的疼痛，需要考虑传统抗炎药物的替代治疗策略。
To investigate the frequency of remaining pain in early rheumatoid arthritis (RA) after 3 months of treatment with methotrexate as the only disease modifying antirheumatic drug, with a special focus on patients with a good clinical response. The study base was cases reported to a population‐based early RA cohort who had followup data from the Swedish Rheumatology Quality Register (n = 1,241). The Disease Activity Score in 28 joints European League Against Rheumatism (EULAR) response criteria were used to evaluate clinical response to treatment as good, moderate, and no response. The primary end point was remaining pain at the 3‐months followup visit, defined as pain >20 mm on a 100‐mm visual analog scale (VAS). Remaining pain in spite of a EULAR good response at followup was associated with higher baseline disability, using the Health Assessment Questionnaire (adjusted odds ratio [OR] 2.2 [95% confidence interval (95% CI) 1.4–3.4] per unit increase), and less baseline inflammation, using the erythrocyte sedimentation rate (adjusted OR 0.81 [95% CI 0.70–0.93] per 10‐mm increase). Similar associations were detected for remaining pain at followup in spite of low inflammatory activity, defined as a C‐reactive protein level <10. Increase in VAS pain during the treatment period was observed in 19% of the whole cohort, with frequencies in the EULAR response groups of 9% (good response), 15% (moderate response), and 45% (no response). These results are in line with the hypothesis that a subgroup of early RA patients exhibits pain that is not inflammatory mediated, where alternative treatment strategies to traditional antiinflammatory medications need to be considered.
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