RA关节功能残疾与软骨破坏的相关性高于骨破坏

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Ann Rheum Dis. 2011 May;70(5):733-9. Epub 2011 Feb 14.   Physical disability in rheumatoid arthritis is associated with cartilage damage rather than bone destruction.   Aletaha D, Funovits J, Smolen JS.   Source Department of Internal Medicine 3, Division of Rheumatology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. daniel.aletaha@meduniwien.ac.at   Abstract   BACKGROUND: Joint destruction in rheumatoid arthritis is comprised of cartilage and bone damage, which can be evaluated radiographically separately by the joint space narrowing (JSN) and erosion (ERO) scores. It is currently unclear to which extent these components affect irreversible functional disability. The aim of the present work was to determine these contributions. METHODS: Data, kindly provided by the sponsors, was evaluated from several randomised controlled clinical trials on adalimumab, etanercept, infliximab and leflunomide. Patients who reached stringent remission according to the Simplified Disease Activity Index (SDAI≤3.3) were extracted to eliminate the activity related (ie, reversible) component of disability. In these patients, residual Health Assessment Questionnaire Disability Index (HAQ-DI) score at the time of remission (to reflect the level of 'irreversible' disability) was determined and related to baseline measures of ERO and JSN scores univariately, by stratification and in adjusted regression models. RESULTS: A total of 748 patients who achieved a state of remission were analysed (16.3% of the total pooled population of 4602 patients). In the univariate analyses, mean residual HAQ-DI values in remission were significantly larger in higher tertiles of JSN and ERO (ERO: 0.21, 0.25, 0.35; JSN: 0.19, 0.24, 0.39; p<0.001 for both). In stratified analyses, mean residual HAQ-DI scores were larger in higher tertiles of JSN within the first tertile of ERO (0.18, 0.25, 0.29; p=0.05), as well as the second (0.21, 0.24, 0.29; p=0.19) and the third (0.12, 0.23, 0.42; p<0.001). In contrast, there was no such trend across ERO tertiles within the first JSN tertile (0.18, 0.21, 0.12; p=0.99) and the second tertile (0.25, 0.24, 0.23; p=0.77), and only marginally within the third tertile of JSN (0.29, 0.29, 0.42; p=0.07). Adjusted multivariate regression models supported the significant association of JSN on residual disability. CONCLUSIONS: Cartilage damage appears to be the more clearly associated with irreversible physical disability than bony damage. These data suggest that particular attention should be given to therapeutic interference with cartilage destruction.   PMID: 21321002

RA关节功能残疾与软骨破坏的相关性高于骨破坏   Aletaha D, Funvits J, Smolen JS. Ann Rheum Dis. 2011. 70:733-9.   背景：类风湿关节炎(RA)关节破坏包括软骨和骨，其评估方法是通过放射学摄片并计算关节腔狭窄(JSN)和骨侵蚀(ERO)评分。目前尚不清楚这些改变需要达到何种程度才能导致不可逆的关节功能残疾。本研究将探讨这些病变对关节功能的影响。 方法：有关阿达木、依那西普、英夫利昔和来氟米特的诸多随机对照临床数据由申办者慷慨提供。为了消除急性炎症对关节功能评估的影响，本研究所用数据仅限于已获得严格的临床缓解标准(SDAI≤3.3)的病人。3) were extracted to eliminate the activity related (ie, reversible) component of disability. 缓解时的健康评估问卷残疾指数（HAQ- DI）残余值反映了“不可逆”的功能残疾。通过分层和校正后的回归模型，将这些病人的HAQ-DI与基线时的ERO和JSN评分进行关联分析。 结果：获临床缓解的患者共有748例（在4602例总患者群中所占比例为16.3％）。在单变量分析中，随着ERO和JSN的三分位阶数增加，缓解病人的平均残留HAQ-DI值也逐渐增高（ERO：0.21，0.25，0.35; JSN：0.19，0.24，0.39，P值均小于0.001）。分层分析在ERO的三分位分组中再按JSN的三分位分组。结果显示在ERO的第一个三分位组中，剩余HAQ-DI平均值随JSN三分位阶数增加而增高（0.18，0.25，0.29，P =0.05），ERO的第二分组（0.21，0.24，0.29，P = 0.19 ）和第三分组（0.12，0.23，0.42，P <0.001）也是如此。相比之下，先按JSN三分位分组再按ERO三分位细分组，却未见上述的HAQ-DI分布趋势，JSN第一分组（0.18，0.21，0.12，P= 0.99），第二分组（0.25，0.24，0.23，P =0.77），第三分组仅有轻微的倾向（0.29，0.29，0.42，P = 0.07）。校正多元回归模型的分析结果也证实JSN与剩余HAQ-DI存在显著关联。 结论：软骨损伤与不可逆关节功能残疾的相关性似乎高于关节骨破坏。这些数据表明我们应该特别关注关节软骨破坏的治疗。