Predictors of Early Minimal Disease Activity in Patients with Psoriatic Arthritis Treated with Tumor Necrosis Factor-α Blockers
Predictors of Early Minimal Disease Activity in Patients with Psoriatic Arthritis Treated with Tumor Necrosis Factor-α Blockers
复制标题
DOI：
10.3899/jrheum.110763
复制
发表时间：
2012-03-01
影响因子：
3.9
通讯作者：
Scarpa, Raffaele
中科院分区：
文献类型：
--
作者：
Iervolino, Salvatore;Di Minno, Matteo Nicola Dario;Scarpa, Raffaele
目标。目的：确定接受肿瘤坏死因子-α(TNF-α)拮抗剂治疗的银屑病关节炎(PSA)患者早期微小疾病活动的预测指标。共有146名符合抗肿瘤坏死因子-α治疗条件的PSA患者入选。在基线(T0)，收集有关年龄、性别、PSA亚型、病程、合并症和治疗的信息。所有受试者都接受了代谢综合征(METS)和/或肝脏脂肪变性的测试。在T0和3个月(T3)进行临床和实验室评估。所有这些变量的变化在达到最小疾病活动度(MDA)的受试者和没有达到最小疾病活动度(MDA)的受试者中进行了比较。在146名PSA受试者中，有10人在3个月随访前因不良事件而停止治疗；因此136人结束了研究。从T0到T3，所有的临床结果指标都发生了显著变化。血沉明显降低(P<；0.001)。C反应蛋白(CRP)、血清胆固醇和甘油三酯无显著变化(p>；0.05)。在有丙二醛的受试者和没有丙二醛的受试者之间，蛋氨酸过敏和肝脏脂肪变性的患病率没有显著差异(分别为p=0.347和0.053)。在T3达到丙二醛的患者比没有达到丙二醛的患者年轻(p=0.001)。在获得丙二醛的受试者中，发现基线压痛关节计数(p=0.001)、肿胀关节计数(p=0.013)、巴斯强直性脊柱炎疾病活动指数(p=0.021)和里奇指数(p=0.006)较低。年龄(OR 0.896，p=0.003)和Bath强直性脊柱炎功能指数(OR 0.479，p=0.007)与丙二醛的达标呈负相关，而C反应蛋白(OR1.78，p=0.018)则直接预测T3时丙二醛的达标。在PSA患者中，治疗开始时的年龄、CRP和BASFI被发现是肿瘤坏死因子-α阻滞剂治疗3个月后丙二醛的可靠预测因子。(2012年1月15日首次发布；J Rheumatol 2012年；39：568-73；.doi：10.3899/jhurum.110763)
Objective. To identify predictors of early minimal disease activity in patients with psoriatic arthritis (PsA) receiving tumor necrosis factor-alpha (TNF-alpha) antagonists.Methods. In total 146 consecutive patients with PsA eligible for anti-TNF-alpha therapy were enrolled. At baseline (T0) information about age, sex, PsA subset, disease duration, comorbidities, and treatments was collected. All subjects were tested for metabolic syndrome (MetS) and/or liver steatosis. A clinical and laboratory evaluation was performed at T0 and at 3 months (T3). Changes in all these variables were compared in subjects achieving minimal disease activity (MDA) and those who did not.Results. Among 146 PsA subjects, 10 discontinued therapy before 3-month followup because of adverse events; thus 136 concluded the study. All clinical outcome measures changed significantly from T0 to T3. Erythrocyte sedimentation rate showed a significant reduction (p < 0.001). C-reactive protein (CRP), serum cholesterol, and triglycerides showed no significant variation (p > 0.05). The prevalence of MetS and liver steatosis showed no significant differences between subjects achieving MDA and those who did not (p = 0.347 and 0.053, respectively). Patients achieving MDA at T3 were younger than those not achieving MDA (p = 0.001). A lower baseline tender joint count (p = 0.001), swollen joint count (p = 0.013), Bath Ankylosing Spondylitis Disease Activity Index (p = 0.021), and Ritchie index (p = 0.006) were found in subjects achieving MDA. Age (OR 0.896, p = 0.003) and Bath Ankylosing Spondylitis Functional Index (BASFI) (OR 0.479, p = 0.007) inversely predicted, whereas CRP (OR 1.78, p = 0.018) directly predicted, achievement of MDA at T3.Conclusion. In patients with PsA, age, CRP, and BASFI at the beginning of treatment were found to be reliable predictors of MDA after 3 months of TNF-alpha blocker therapy. (First Release Jan 15 2012; J Rheumatol 2012;39:568-73;.doi:10.3899/jrheum.110763)