基线预测经DMARDs治疗获缓解RA病人未来复发与放射学进展

原文

译文

OP0061

PREDICTION OF FLARE AND LONG TERM OUTCOME IN DMARD-TREATED RA PATIENTS IN REMISSION: THE VALUE OF IMAGING AND NEW REMISSION CRITERIA

B. Saleem ^{1, 2,*}, A. K. Brown ^{3, 4}, M. Quinn ^{4, 5}, Z. Karim ¹, E. Hensor ^{1, 2}, P. G. Conaghan ^1,
2, R. Wakefield ^{1, 2}, P. Emery ^1,
2

¹Academic Unit of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, ²NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, ³Hull York Medical School, University of York, ⁴Department of Rheumatology, ⁵Hull York Medical School, York Teaching Hospital NHS Foundation Trust, York, United Kingdom

Background: Disease remission is the primary treatment target for patients with rheumatoid arthritis (RA). However, despite achieving this state, some may still experience flares of disease activity and suboptimal outcomes.

Objectives: This study aimed to determine the clinical, biochemical and imaging predictors of disease flare and sustained remission, in a cohort of disease modifying anti-rheumatic drug (DMARD) treated RA patients in clinical remission, and evaluate the relative merits of the established definitions of remission in this setting. In addition we aimed to determine the impact of disease flare versus sustained remission on long term, clinical, functional, quality of life and radiographic outcomes.

Methods: RA patients in clinical remission as determined by their treating consultant rheumatologist were assessed using clinical, biochemical, imaging, functional and quality of life measures over 12 months. Flare was defined as any increase in disease activity requiring a change in therapy.

Results: Of the 93 patients recruited, 24 flared during the study period. Comparing patients that flared with those in sustained remission, there were no differences in baseline characteristics. Neither fulfilment of DAS28, SDAI, 1981 ACR nor 2010 ACR/EULAR Remission Criteria was associated with a reduced likelihood of flare. However increased ultrasound (US) power Doppler (PD) activity at baseline was associated with increased chance of flare [OR 4.08 (1.26-13.19); P=0.014). Patients that flared had significantly worse long term clinical, functional and quality of life outcomes at 12 months compared to patients in sustained remission.

Conclusions: In this DMARD-treated clinical remission cohort, annual flare rate was 26%. The major factor determining the likelihood of future disease flare was PD activity and the best predictor of sustained remission was absence of PD signal. These data confirm the utility of PD in the management of RA patients and suggests that US should form an important part of remission assessment criteria.

基线预测经DMARDs治疗获缓解RA病人未来复发与放射学进展

B. Saleem, EULAR 2011. Present No: OP0061

背景：疾病缓解是类风湿关节炎患者的主要治疗目标。然而，不管是否能达到缓解，很多患者仍然会疾病复发和预后不良。

目标：本研究旨在确定DMARD治疗获得临床缓解的RA患者中疾病复发和持续缓解的临床、生物学和影像学预测值，并评价现有缓解定义的相关优点。同时，还希望明确疾病复发与持续缓解对于长期的临床、功能、生活质量和影像学结局的影响。

方法：RA患者的临床缓解由主诊的风湿病医生确认，并评估其12个月的临床、生化、影像学、功能和生活质量指标。复发定义为任何疾病活动度的增加并需要调整治疗。

结果：共93例患者入组，研究阶段中有24例复发。与持续缓解的患者相比，基线水平的疾病指标两组间无差异。不论是DAS28，SDAI，1981ACR或2010ACR/EULAR缓解标准与减少复发不相关。但是，基线水平时的能量多普勒超声活动度与复发的机率正相关[OR 4.08 (1.26-13.19); P=0.014)。复发的患者在12个月时长期临床、功能和生活质量都明显差于持续缓解者。

结论：在本研究DMARD治疗的临床缓解病例中，每年的复发率为26%。决定未来复发的主要影响因子为PD活动度，而长期缓解的最佳预测值为PD信号阴性。本结果确认了PD在RA治疗中的应用价值，并建议US应该成为缓解评价标准中的重要内容。