早期RA获超声缓解的基线预测因素

原文

译文

THU0033

LOWER ESR AND SWOLLEN JOINT COUNT AT BASELINE PREDICT HIGHER RATES OF POWER DOPPLER ULTRASOUND REMISSION IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS TREATED FOLLOWING A TARGETED PROTOCOL.

S. Chitale ^1,*, C. Estrach ¹, R. N. Thompson ¹, R. J. Moots ¹, N. J. Goodson ¹

¹Rheumatology, Aintree University Hospital, University of Liverpool, Liverpool, United Kingdom

 

Background: Evidence shows that treating early rheumatoid arthritis (eRA) with disease modifying anti-rheumatic drugs (DMARDs) to attain a pre-determined target achieves better long-term outcome [1]. Power Doppler Ultrasound (PDUS) remission is increasingly recognised as a potential target of DMARD therapy in eRA and helps identify an ‘inflammation free’ state. Little information exists about baseline predictors of PDUS remission in eRA.

Objectives: To identify baseline variables predicting PDUS remission in newly diagnosed eRA patients treated with a targeted remission induction protocol (TRI-P).

Methods: Patients with a clinical diagnosis of eRA (inflammatory polyarthritis of rheumatoid type , symptom duration ≤ 12 months) completing Aintree Early Arthritis Clinic(AEAC) TRI-P were studied [3]. Patients in DAS28 remission or DAS28 > 2.6 without clinically swollen joints (2 scores a month apart without interim DMARD escalation or steroid therapy) had PDUS remission assessment. PDUS remission was defined as PD ≤ 1 in ≤ 1 joint/tendon in hand and feet joints. Multivariate logistic modelling of baseline covariates (table1) was used to identify independent predictors of PDUS remission.  

Results: 172 eRA patients between May 2006-August 2010 were studied. 92% met 2010 ACR-EULAR classification criteria at presentation. 149 (87%) achieved US-PD remission, of which 72 (48%) were also in DAS28 remission. Table 1 shows all baseline covariates examined. The final multivariate model revealed that baseline swollen joint count (SJC)-28 <3   (OR 4.2 (1.4, 13.6)) and ESR/ mm/hr (OR 0.98 (0.96, 0.99)) remained independent predictors of PDUS remission. Male gender had a trend for predicting PDUS remission (OR 2.8 (0.9, 8.5)) but no other baseline covariates were significantly associated with PDUS remission.

Conclusions: This study identifies that lower baseline ESR and low SJC-28 at presentation increase the likelihood of achieving PDUS. PDUS remission appears to reflect more stringently, a low level of inflammatory joint disease and may prove to be a more effective treatment target when trying to prevent joint damage in eRA. The ability to identify patients at baseline with increased risk of prolonged PDUS activity may help guide therapeutic interventions in eRA.

References: 1.Smolen J et. al. Ann Rheum Dis.  Apr; 69(4):631-637.2.Chitale S. et. al. Ann Rheum Dis 2010;69 S(3): 493.

 Table 1. Baseline covariates assessed as predictors of PDUS remission.

Baseline Variables	Whole group n (%)= 172(100)	In PDUS remission n (%)= 149 (87)	Not in PDUS remission n(%)= 23 (13)
Age mean(SD)	57.6 (16)	57(15)	62(17)
Female gender n (%)	108 (63)	90 (60)	17 (77)
Current Smoker n (%)	52(31)	49(33)	3 (13)
Tender joint count (TJC)-28 < 8 n(%)	78 (45)	68 (45)	10 (44)
Swollen joint count (SJC)-28 < 3 n(%)	75 (44)	71 (48)	4 (17)
Patient reported global health (GH) < 60 n(%)	84 (49)	74 (50)	10 (44)
ESR mm/hr median [IQR]	34.5[23, 53.5]	33[23, 49]	52[34, 73]
ACPA ≥ 600 IU/ml n(%)	41 (24)	37 (25)	4 (17)
Presence of US erosions n(%)	38 (22)	31 (21)	7 (32)
Symptom duration ≤ 3 months n (%)	78 (45)	66(44)	12 (52)
Triple DMARD therapy at diagnosis	23 (13)	20(13)	3(13)

 

早期RA获超声缓解的基线预测因素

S. Chitale , EULAR 2011. Present No: THU0033

 

背景： 有证据显示为达到预设目标早期类风湿关节炎（eRA）应用改善病情抗风湿药物（DMARDs）治疗可以获得更好的长期结果。能量多普勒超声（PDUS）缓解作为DMARD治疗eRA的潜在目标并识别“无炎症”状态越来越受到重视。但有关eRA患者PDUS缓解的基线水平预测值的信息却很少。

 

目标：探索新诊断的eRA患者接受目标缓解诱导方案（TRI-P）治疗后，能达到PDUS缓解的基线水平预测值。

 

方法：临床诊断eRA（炎症性类风湿型的多关节炎，症状起病≤ 12个月）并完成Aintree 早期关节炎临床中心（AEAC）TPI-P的患者入组本研究。对DAS28缓解或DAS28〉2.6而没有临床肿胀关节（一个月2分而没有临时DMARD升级或激素治疗）的患者进行PDUS缓解评估。PDUS缓解定义为手足关节≤ 1个关节/肌腱的PD≤ 1 。多因素回归模型分析了基线水平多种变量中PDUS缓解的独立预测值（表1）。

 

结果： 2006年5月至2010年8月共172例eRA患者参与本研究。就诊时有92%患者符合2010 ACR-EULAR分类标准。149（87%）例患者获得US-PD缓解，其中72（48%）例同时达到DAS28缓解。表1显示所有检测的基线水平变量。最终的多因素回归模型发现基线水平时的肿胀关节数(SJC)-28 <3   (OR 4.2 (1.4, 13.6))和ESR/ mm/hr (OR 0.98 (0.96, 0.99)) 是PDUS缓解的独立预测因素。男性

似乎更易达到PDUS缓解（OR2.8 （0.9，8.5）），但没有其它基线水平变量与PDUS缓解显著相关。

 

结论：本研究发现患者就诊时的低水平ESR和低SJC-28使达到PDUS缓解的可能性增高。PDUS缓解能更严格地反映病变关节的低水平炎症，并更好地证实eRA中预防关节破坏治疗的有效性。在基线水平识别持续PDUS活动风险增高的患者将有助于指导eRA患者的干预治疗。

表1.预测PDUS缓解的基线变量

基线变量	全组 n (%)= 172(100)	PDUS缓解 n (%)= 149 (87)	PDUS 未缓解 n(%)= 23 (13)
平均年龄(SD)	57.6 (16)	57(15)	62(17)
女性 n (%)	108 (63)	90 (60)	17 (77)
目前吸烟 n (%)	52(31)	49(33)	3 (13)
压痛关节计数 (TJC)-28 < 8 n(%)	78 (45)	68 (45)	10 (44)
肿胀关节计数 (SJC)-28 < 3 n(%)	75 (44)	71 (48)	4 (17)
患者总体健康(GH) < 60 n(%)	84 (49)	74 (50)	10 (44)
ESR mm/hr 中位 [IQR]	34.5[23, 53.5]	33[23, 49]	52[34, 73]
ACPA ≥ 600 IU/ml n(%)	41 (24)	37 (25)	4 (17)
出现超声骨侵蚀 n(%)	38 (22)	31 (21)	7 (32)
症状持续时间 ≤ 3 months n (%)	78 (45)	66(44)	12 (52)
诊断时DMARD 三联治疗	23 (13)	20(13)	3(13)