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Ann Rheum Dis doi:10.1136/ard.2010.142729 Very early rheumatoid arthritis is the major predictor of major outcomes: clinical ACR remission and radiographic non-progression
1. Silvia Bosello, 3. Giusy Peluso, 4. Elisa Gremese, 5. Barbara Tolusso,
Abstract Objectives To identify predictors of clinical remission as well as of no x-ray progression in a cohort of early rheumatoid arthritis (ERA) treated with a tight-control protocol. Methods A total of 121 consecutive patients with ERA were treated to reach European League Against Rheumatism (EULAR) and/or American College of Rheumatology (ACR) clinical remission with methotrexate (MTX) for 3 months, then with a combination with anti-tumour necrosis factor if the patient did not achieve a 44-joint Disease Activity Score (DAS44) ≤2.4. At baseline and after 12 months all the patients had hand and foot joint radiographs. Very early rheumatoid arthritis (VERA) was defined as a disease with symptoms of less than 12 weeks. Results In all, 46.3% of the patients reached DAS remission and 24.8% achieved ACR remission. More than 60% of patients reached remission with MTX. Male sex and an erythrocyte sedimentation rate <35 mm/h at onset arose as significant predictors of EULAR remission, while VERA disease was the only predictor of ACR remission. At baseline, 28.1% of the patients were erosive. Multivariate analysis demonstrated that the only independent predictor of erosiveness was ‘not having VERA disease’. After 12 months, VERA was the only factor predicting a lack of new erosions. Conclusions VERA represents the best therapeutic opportunity in clinical practice to achieve a complete remission and to stop the erosive course of rheumatoid arthritis.
| 极早期RA是获得ACR缓解和放射学无进展的主要预测因素 Bosello S, et al. Ann Rheum Dis doi:10.1136/ard.2010.142729.
目的: 用严密控制(tight control)方案治疗早期类风湿关节炎(ERA)时,找出临床缓解以及X线无进展的预测因素。 方法: 顺序收治121例ERA病人。治疗目标是达到EULAR或ACR定义的临床缓解。治疗方案是先用甲氨蝶呤(MTX)治疗3个月,对DAS44≤2.4的病人加用TNF拮抗剂。在基线和治疗12个月时,所有病人进行手足X线摄片。极早期RA的定义是关节炎病程不足12周。 结果 : 治疗12个月时,DAS44缓解率为46.3%,ACR缓解率为24.8%。单用MTX治疗3个月就获得缓解的病人比例超过60%。获得EULAR缓解的预测因素包括:男性,发病时ESR<35 mm/h,获得ACR缓解的预测因素仅有VERA。基线时,骨侵蚀阳性比例为28.1%。多变量分析证明侵蚀性疾病的独立预测因素仅有一项,即 “不是VERA”。治疗12个月后未出现新发侵蚀灶的预测因素是VERA。 结论 : 在常规诊疗中,VERA代表了最佳治疗时机,能获得完全缓解,并阻断RA的骨侵蚀。
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转载于:https://www.cnblogs.com/T2T4RD/archive/2011/05/16/5464294.html