Earlier Time to Remission Predicts Sustained Clinical Remission in Early Rheumatoid Arthritis - Results from the Canadian Early Arthritis Cohort (CATCH)
Earlier Time to Remission Predicts Sustained Clinical Remission in Early Rheumatoid Arthritis - Results from the Canadian Early Arthritis Cohort (CATCH)
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DOI：
10.3899/jrheum.140137
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发表时间：
2014-11-01
影响因子：
3.9
通讯作者：
Bykerk, Vivian
中科院分区：
文献类型：
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作者：
Kuriya, Bindee;Xiong, Juan;Bykerk, Vivian
Objective.评估早期类风湿关节炎（ERA）人群中持续缓解的患病率和预测因素。ERA持续缓解的预测因素尚不清楚。我们假设短时间缓解是持续临床缓解的重要预测因素。纳入了加拿大早期关节炎队列中的患者。缓解由基于布尔的美国风湿病学会/欧洲抗风湿病联盟临床试验和临床实践定义以及简化疾病活动指数（SDAI）定义。Logistic回归分析确定了持续缓解的预测因素和缓解时间的影响。在1840例患者中，633例（34%）达到临床试验缓解，759例（41%）达到临床实践缓解，727例（39%）达到SDAI缓解。根据临床试验（55%）、临床实践（60%）和/或SDAI（58%），超过一半符合缓解标准的患者实现了持续缓解。糖皮质激素的使用和缺乏初始病情缓解抗风湿药（DMARD）与持续缓解的可能性降低，而初始组合DMARD增加这种可能性。女性、更大的疼痛和更长的首次缓解时间使持续缓解的可能性降低。女性、更大的疼痛和缺乏初始DMARD治疗降低了持续缓解的可能性。较短的缓解时间与可持续性有关，并支持争取早期缓解。
Objective. To evaluate the prevalence and predictive factors of sustained remission in an early rheumatoid arthritis (ERA) population. Predictive factors of sustained remission in ERA are unknown. We hypothesized that a short time to remission is an important predictor of sustained clinical remission.Methods. Patients in the Canadian Early Arthritis Cohort were included. Remission was defined by Boolean-based American College of Rheumatology/European League Against Rheumatism clinical trial and clinical practice definitions and Simplified Disease Activity Index (SDAI). Logistic regression analysis identified predictors of sustained remission and influence of time to remission.Results. Of 1840 patients, 633 (34%) achieved clinical trial remission, 759 (41%) clinical practice remission, and 727 (39%) SDAI remission. Over half of those meeting remission criteria achieved sustained remission based on clinical trial (55%), clinical practice (60%), and/or SDAI (58%). Corticosteroid use and lack of initial disease-modifying antirheumatic drug (DMARD) were associated with decreased probability of sustained remission, while initial combination DMARD increased this probability. Female sex, greater pain, and longer time to first remission made sustained remission less likely.Conclusion. Female sex, greater pain, and lack of initial DMARD therapy reduced the probability of sustained remission. A shorter time to remission is related to sustainability and supports striving for early remission.