不同缓解标准评价早期关节炎的持续缓解率不同

作者:发布时间:2014/7/4 8:41:51
不同缓解标准评价早期关节炎的持续缓解率不同 
 徐宁
        摘要:
        目的:评价早期关节炎缓解率,评价采用在不同的标准定义缓解的一致性,并寻找早期和持续缓解的预测因素。  
        方法:研究患者来源于ESPOIR队列,每6个月随访一次。我们分析了三组患者的早期及持续缓解率。类风湿关节炎组(根据2010年ACR/EULAR诊断标准),未分化关节炎组及全队列。缓解标准分别采用ACR/EULAR标准,关节疾病活动评分DAS28评分小于2.6及简化疾病活动指数SDAI≤3.3。一致性分析采用k-系数。并分析RA患者的1年,3年及5年持续缓解的预测因素。  
        结果:本研究包括819名患者。在类风湿关节炎、未分化关节炎及全队列三组,采用关节疾病活动评分DAS28标准,早期缓解率分别为29.2% (181/682)、51.4% (55/123) 和 32.7% (239/813);采用简化疾病活动指数SDAI,早期缓解率分别为15.7%、29.1%和18%;而采用ACR/EULAR标准时,三组缓解率分别为 11.2%、29.1%和12.8%。不同缓解定义组之间一致性分析显示,关节疾病活动评分DAS28 与ACR/EULAR 一致性较低(k=0.44), 简化疾病活动指数SDAI 与ACR/EULAR一致性最高 (k=0.78),而 SDAI 与 DAS28为中等一致性 (k=0.54)。3个不同缓解定义组均显示,基线低疾病活动评分、非绝经状态及年龄是最佳的持续缓解预测因素。 
        结论:我们的研究显示,因为“缓解”标准间存在不同程度差异,因此早期关节炎的早期及持续缓解率依赖于采用标准。但在最终诊断为类风湿关节炎的患者,其预后预测指标一致。  
        附原文:OBJECTIVES:To assess the prevalence of remission in early arthritis, to evaluate the concordance across different criteria sets in defining this state, and to look for predictive factors for early and sustained remission.METHODS:Patients from the ESPOIR cohort were followed-up every 6months. We analysed early remission and sustained remission in 3 groups of patients: patients having rheumatoid arthritis (RA) according to 2010 ACR/EULAR criteria,undifferentiated arthritis (UA), and the whole cohort. Remission was defined according to ACR/EULAR criteria, 28 Joint Disease Activity Score (DAS28<2.6), and Simplified Disease Activity Index (SDAI≤3.3). Agreement was evaluated by k-coefficient. Predictive factors for sustained remission at 1, 3 and 5year in RA patients were analyzed.RESULTS: Eight hundred and nineteen patients were included. Early remission rates in the RA/UA/ESPOIR groups were observed in respectively 29.2% (181/682), 51.4% (55/123) and 32.7% (239/813) of patients by DAS28; 15.7%, 29.1% and 18% by SDAI; and 11.2%, 29.1% and 12.8% by ACR/EULAR criteria. Agreement between classifications of remission was low for DAS28 vs. ACR/EULAR (k=0.44), high for SDAI vs. ACR/EULAR (k=0.78), and moderate for SDAI vs. DAS28 (k=0.54). Lower baseline disease activity scores, non-menopausal status and younger age were the best predictive factors for sustained remission, with consistent results across the 3 definitions of remission.Our study showed that the rate of early and sustained remission in early arthritis is dependent on the definition used, with a variable degree of agreement across criteria sets, but with consistent predictive factors of favourable outcome in patients finally diagnosed with RA.  
        引自:Hmamouchi I1, Combe B2, Fautrel B3, Rincheval N2, Lukas C2. Prevalence and concordance of early and sustained remission assessed by various validated indices in the early arthritis "ESPOIR" cohort. Joint Bone Spine. 2014 Apr 1. pii: S1297-319X(14)00051-7. doi: 10.1016/j.jbspin.2014.02.007.