MMP-3 as a predictor for structural remission in RA patients treated with MTX monotherapy.
MMP-3 as a predictor for structural remission in RA patients treated with MTX monotherapy.
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DOI：
10.1186/s13075-016-0948-7
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发表时间：
2016-02-27
影响因子：
4.9
通讯作者：
Shiozawa S
中科院分区：
文献类型：
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作者：
Shiozawa K;Yamane T;Murata M;Yoshihara R;Tsumiyama K;Imura S;Shiozawa S
该研究旨在评估甲氨蝶呤 (MTX) 单药治疗对类风湿性关节炎 (RA) 患者放射学进展的疗效，每位患者均已接受 MTX 单药治疗 3 年，并可选择改用生物疾病缓解抗风湿药物 (bDMARD)。我们还寻找这些患者的影像学无进展的预测因素。类风湿患者 (n = 161) 在接受低剂量 MTX 单药治疗的同时进行了 3 年的前瞻性随访，除非疾病处于活跃状态和/或出现不良事件。参照疾病活动评分28（DAS28）、改良健康评估问卷（mHAQ）等指标评估其疾病活动度和影像学进展。使用概率图评估每年 van der Heijde 修正总 Sharp 评分 (ΔTSS) 的变化，其中患者被分为显示结构性缓解 (REM; ΔTSS ≤0.5)、放射学进展 (ΔTSS >3) 或快速放射学进展 (RRP; ΔTSS >5) 的亚组。 MTX 单药治疗持续到疾病变得活跃和/或不良事件出现，与从基线到 3 年的 DAS28-ESR (3) 评分、DAS28 缓解百分比和 mHAQ 评分每年的显着改善 (p<0.0001) 相关。 mHAQ 缓解率 (ΔmHAQ <0.5) 和布尔缓解率也分别从 16% 提高到 60% 和 0.8% 提高到 24.0%。我们发现，REM 患者的比例从 62/161 (38.5%) 逐年增加到 69/137 (50.4%)，而 ΔTSS >3 的患者比例从 55/161 (34.2%) 下降到 28/137 (20.4%)，RRP 患者的比例从 35/161 (21.7%) 下降到15/137 (10.9%)。受试者工作特征 (ROC) 曲线分析显示，一开始血清基质金属蛋白酶 3 (MMP-3) <103.7 ng/ml 预示患者亚组不会出现放射学进展。接受 MTX 单药治疗 3 年的类风湿患者中有一半表现出结构性缓解，这一结果可以通过较低的血清 MMP-3 来预测。本文的在线版本 (doi:10.1186/s13075-016-0948-7) 包含补充材料，可供授权用户使用。
The study was undertaken to assess the efficacy of methotrexate (MTX) monotherapy on the radiographic progression of individual rheumatoid arthritis (RA) patients, each of whom had received MTX monotherapy for 3 years with an option to change to biological disease-modifying anti-rheumatic drugs (bDMARDs). We also looked for predictors of radiographic non-progression in these patients. Rheumatoid patients (n = 161) were prospectively followed for 3 years while receiving low-dose MTX monotherapy unless disease was otherwise active and/or adverse events appeared. Their disease activity and radiographic progression were evaluated with reference to disease activity score 28 (DAS28), modified health assessment of questionnaire (mHAQ) and other indices. The change in van der Heijde-modified total Sharp score per year (∆TSS) was assessed using probability plots, in which the patients were classified into the subgroups showing structural remission (REM; ∆TSS ≤0.5), radiographic progression (∆TSS >3) or rapid radiographic progression (RRP; ∆TSS >5). MTX monotherapy, continued until disease became active and/or adverse event appeared, was associated with a significant improvement (p <0.0001) in the DAS28-ESR (3) scores, % DAS28 remission, and mHAQ scores each year, from baseline to 3 years. The mHAQ remission rate (∆mHAQ <0.5) and Boolean remission were also improved from 16 to 60 % and 0.8 to 24.0 %, respectively. We found that the ratio of patients classified as REM increased yearly from 62/161 (38.5 %) to 69/137 (50.4 %), while those classified as ∆TSS >3 decreased from 55/161 (34.2 %) to 28/137 (20.4 %) and those in RRP decreased from 35/161 (21.7 %) to 15/137 (10.9 %). Receiver operating characteristic (ROC) curve analyses showed that serum matrix metalloproteinase-3 (MMP-3) <103.7 ng/ml at outset predicts a patient subgroup that exhibits no radiographic progression. Half of rheumatoid patients treated with MTX monotherapy for 3 years exhibited structural remission, and this outcome can be predicted at the outset by lower serum MMP-3. The online version of this article (doi:10.1186/s13075-016-0948-7) contains supplementary material, which is available to authorized users.