ACR2010_对MTX单药治疗初始反应良好的早期RA患者经过2年治疗临床结局优良，但不能完全阻止放射学进展

初始接受MTX单药治疗3～4个月、达到DAS28<3.2的早期RA患者在单用MTX治疗的2年间临床反应良好，很少需要其它治疗。然而，放射学进展仍在发生，且可见于维持缓解和（或）仅用MTX单药治疗的患者。
              

原文	译文
[1393] - In Early RA, Patients with a Good Initial Response to MTX Monotherapy Have Excellent Clinical Outcomes over Two Years of Therapy, but Radiological Progression Is Not Completely Prevented. Helena Wallin, MD 1,Ronald Van Vollenhoven, MD, PhD2,Kristina Albertsson, MD PhD,Kristina Forslind,Sofia Ernestam,Ingemar F Petersson, MD3,Pierre Geborek,Hamed Rezaei,Johan Bratt, MD, PhD4,. The SWEFOT study group. 1The Karolinska Institute, Stockholm,2Rheumatology Unit, Karolinska University Hospital, Stockholm,3,4Musculoskeletal Research Dept, Lund University Hosp, Lund,5Dep of Rheum, Karolinska Univ Hosp Huddinge, Stockholm Background: In the SWEFOT trial, all patients were initially given MTX monotherapy for 3-4 months; patients achieving a DAS28<3.2 were not randomized in the controlled portion of the trial. We previously demonstrated that this was the case for 30% of the patients, most of whom maintained remission during the first year. Here, we investigated the clinical and radiological results in these patients over two years of follow-up. Objectives: To analyze the clinical and radiological course in patients from the SWEFOT study who responded adequately to initial MTX monotherapy and were not included in the randomized trial. Methods: A total of 487 patients with early RA (symptom duration <1 year) were started on MTX at a rapidly escalating dosage up to at least 20 mg/week. After 3-4 months, the 147 patients who had a DAS28<3.2 were not randomized but continued on MTX and were followed in “regular care”, including 3-monthly assessments. These patients were analyzed here. Complete data at 24 months were available for 65% of patients. Results: The majority of patients continued on MTX monotherapy. In 15 patients MTX was replaced by or complemented with another DMARD or a biologic. DAS28 values in all patients are shown in the figure, and demonstrate low values throughout. At the 6, 12, 18 and 24 months time-points, 61.1%, 61.0%, 64.2%, and 72.7% of patients, respectively, were in DAS28 remission, and 82.1 - 87.6% had a low disease activity state. The mean (SEM) progression in total Sharp-vdHeijde score at 24 months was 3.90 (0.68). For the subset of patients who had been in sustained remission at each time point from 3 to 24 months (n=18) the progression was 4.06 (1.85). Progression in patients on MTX monotherapy throughout follow-up was 3.97 (0.85).	对MTX单药治疗初始反应良好的早期RA患者经过2年治疗临床结局优良，但不能完全阻止放射学进展   Wallin H, et la. ACR 2010. Present No: 1393   背景：在SWEFOT试验中，所有患者初始接受MTX单药治疗3-4个月，达到DAS28<3.2的患者未随机进入试验的对照组。我们之前报道了达到此疗效标准的患者达30%，其中大部分在第一年维持缓解。在此，我们观察这些患者2年后的临床和放射学改变。 目的：分析SWEFOT研究中对MTX单药治疗初始反应良好、未进入随机研究的患者临床和放射学改变。 方法：487例早期RA患者（症状持续时间小于1年）初始采用MTX治疗，快速增量至20 mg/周以上。3～4个月后，147例患者达到DAS28<3.2，他们未进入随机试验，继续使用MTX并进行随访，每3个月评估一次。本研究对这些患者进行分析。65%患者完成了24个月的随访。 结果：大部分患者持续使用MTX单药治疗。15例患者换用或加用了另一种DMARD或生物制剂。图中显示了所有患者的DAS28评分始终保持低值。在第6、12、18和24个月，达到DAS28缓解的患者分别为61.1%、61.0%、64.2%和72.7%，82.1% ～ 87.6%处于低疾病活动度。 在第24个月，总Sharp-vdHeijde评分的平均进展（SEM）为3.90（0.68）。在从第3个月到第24个月的各时间点均维持缓解的18例患者中，进展为4.06（1.85）。随访期仅用MTX单药治疗的患者的进展为3.97（0.85）。
Conclusion: Patients who respond to an initial 3-4 month trial of MTX monotherapy with a DAS28<3.2 continue to have very good clinical responses for two years, and additional treatment is needed infrequently. However, radiographic progression does occur and is seen even in those patients who have sustained remission and/or stay on MTX monotherapy. An initial good response to MTX appears to portend a good clinical prognosis but close monitoring of radiological disease is warranted.	结论：初始接受MTX单药治疗3～4个月、达到DAS28<3.2的早期RA患者在单用MTX治疗的2年间临床反应良好，很少需要其它治疗。然而，放射学进展仍在发生，且可见于维持缓解和（或）仅用MTX单药治疗的患者。MTX初始反应良好预示临床预后较好，但应严密监测放射学病变。