极早期RA是获得ACR缓解和放射学无进展的主要预测因素

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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, 2.       Anna Laura Fedele, 3.       Giusy Peluso, 4.       Elisa Gremese, 5.       Barbara Tolusso, 6.       Gianfranco Ferraccioli   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。