Baseline Objective Inflammation by Magnetic Resonance Imaging as a Predictor of Therapeutic Benefit in Early Rheumatoid Arthritis With Poor Prognosis.
Baseline Objective Inflammation by Magnetic Resonance Imaging as a Predictor of Therapeutic Benefit in Early Rheumatoid Arthritis With Poor Prognosis.
复制标题
磁共振成像基线客观炎症作为预后不良的早期类风湿关节炎治疗效果的预测因子。
DOI：
10.1002/acr.24072
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发表时间：
2020
影响因子：
4.7
通讯作者：
Conaghan,PhilipG
中科院分区：
文献类型：
--
作者：
Ahmad,HarrisA;Baker,JoshuaF;Østergaard,Mikkel;Emery,Paul;Durez,Patrick;Ye,June;Banerjee,Subhashis;Conaghan,PhilipG
目的高磁共振成像 (MRI) 检测到的炎症与类风湿性关节炎 (RA) 的更大进展和更差的结果相关。本分析旨在确定基线 MRI 炎症是否与评估极早期类风湿性关节炎治疗 (AVERT) 研究中的临床反应和缓解相关。方法 AVERT 是一项 IIIb 期随机对照试验，为期 12 个月、双盲治疗期，招募早期（≤2 年持续时间）抗瓜氨酸肽阳性甲氨蝶呤 (MTX) 初治 RA 患者。在这项事后分析中，根据先前制定的单侧手腕对比增强 MRI 上滑膜炎和骨炎的界限，将具有可用 MRI 结果的阿巴西普加 MTX (n = 114) 和 MTX (n = 111) 组的患者分为低基线和高基线 MRI 炎症组。使用 C 反应蛋白水平 (<2.6) 评估了 28 个关节的简化疾病活动指数 (SDAI) 缓解 (≤3.3)、临床疾病活动指数 (CDAI) 缓解 (≤2.8)、布尔缓解和疾病活动评分 (<2.6)。 结果 总体而言，225 名患者中有 100 名 (44.4%) 具有高基线 MRI 炎症。在高基线 MRI 炎症的患者中，在 SDAI（45.1% 比 16.3%；P= 0.0022）、CDAI（47.1% 比 20.4%；P= 0.0065）和布尔指数（39.2% 比 16.3%；P= 0.0156）中，阿巴西普加 MTX 与 MTX 相比，12 个月时获得缓解的比例显着更高。在低基线 MRI 炎症患者中，阿巴西普加 MTX 与 MTX 的缓解率没有显着差异（SDAI：39.7% 对比 32.3%；P= 0.4961）。 结论 在血清反应阳性、未接受过 MTX 的早期 RA 患者中，并且存在 MRI 客观测量的高炎症（表明预后不良），阿巴西普加 MTX 治疗的缓解率高于 MTX。
ObjectiveHigh magnetic resonance imaging (MRI)–detected inflammation is associated with greater progression and poorer outcomes in rheumatoid arthritis (RA). This analysis aimed to determine if baseline MRI inflammation was related to clinical response and remission in the Assessing Very Early Rheumatoid arthritis Treatment (AVERT) study.MethodsAVERT was a phase IIIb, randomized, controlled trial with a 12‐month, double‐blind treatment period enrolling patients with early (≤2 years' duration), anti‐citrullinated peptide–positive methotrexate (MTX)‐naive RA. In this post hoc analysis, patients in the abatacept plus MTX (n = 114) and MTX (n = 111) arms with available MRI results were stratified into low and high baseline MRI inflammation groups based on previously developed cutoffs of synovitis and osteitis on unilateral hand–wrist contrast‐enhanced MRI. Simplified Disease Activity Index (SDAI) remission (≤3.3), Clinical Disease Activity Index (CDAI) remission (≤2.8), Boolean remission, and Disease Activity Score in 28 joints using the C‐reactive protein level (<2.6) were assessed.ResultsOverall, 100 of 225 patients (44.4%) had high baseline MRI inflammation. In patients with high baseline MRI inflammation, a significantly greater proportion achieved remission at 12 months with abatacept plus MTX versus MTX across SDAI (45.1% versus 16.3%;P= 0.0022), CDAI (47.1% versus 20.4%;P= 0.0065), and Boolean indices (39.2% versus 16.3%;P= 0.0156). In patients with low baseline MRI inflammation, remission rates were not significantly different with abatacept plus MTX versus MTX (SDAI: 39.7% versus 32.3%;P= 0.4961).ConclusionIn seropositive, MTX‐naive patients with early RA and presence of objectively measured high inflammation by MRI, indicating poor prognosis, remission rates were higher with abatacept plus MTX treatment versus MTX.