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[315] - Low Rate of Rheumatoid
Arthritis Remission in Real Life: Might Predictive Factors
Explain?
Elodie Loppin, MD
1,Ronan
Garlantezec2,Elisabeth Solau-Gervais, MD,
PhD1. 1rheumatology department university
hospital Poitiers,2Public Heatlh department, university
hospital Brest
Objective: Remission constitutes the best
achievable state in patients with rheumatoid arthritis (RA).
Remission rates in usual clinical care are much more lower than the
one in randomized clinical trials (1). The objective of the study
was to define remission factors in “real life”.
Methods: Remission has been assessed retrospectively for
records of 364 patients with rheumatoid arthritis receiving usual
care. These patients were out and in patients followed in an
university hospital with at least one visit in year 2008. Disease
activity was evaluated on records according to DAS 28 criteria.
Remission was defined by a DAS28 < 2.6.Statistical
analysis used Chi-2 and multivariate analysis with the software
SAS9.
Results: The evaluation of disease activity was available
for 328 patients (90 %). Mean age of the patients was 63 years
(+/-13,7) and mean duration of the disease was 13,6 (+/-10,7).
Rheumatoid factor and anti-CCP was positive respectively in 79.3%
and 73.8 %. Eighty five percent had an erosive disease. The rate of
global remission was 28 %. Factors associated statistically with
remission in multivariate analyse were (Ors 95% confidence
intervals): male sex (0,2-0,8), younger age (0,2-0,9), rheumatoid
factor-positive (1,2-6,5) and the absence of concomitant
prednisolone treatment (0,3-0,9). Younger age and rheumatoid
factor-positive represents more a population with a “higher
therapeutic objective” and female sex and older age patients have
more a difference in the evaluation of the disease, rather than
true differences in RA activity. Moreover, the remission rate was
significantly different according to the treatment: 15% without
DMARDs or biotherapy, 24% with DMARDs and 47% with anti-TNF alpha
treatment. As regards to the three anti-TNF alpha, the remission
rate was the lowest for infliximab (18%), than etanercept (43%).
Patients treated with adalimumab had the highest rate of remission
with 64%. The difference was significant between infliximab and
adalimumab (OR : 1.2-101) and between infliximab and etanercept (OR
:1,1-30,15) but not between etanercept and adalimumab.
Conclusion: Male sex, younger age, rheumatoid
factor-positive and corticoids free are associated with remission.
Assessing remission in clinical practice is possible, and
etanercept and adalimumab treatments are associated with higher
rate of remission.
(1) Sokka T, Hetland ML, Makinen H, Kautiainen H, Horslev-Petersen
K, Luukkainen RK, et al. Remission and rheumatoid arthritis: data
on patients receiving usual care in twenty-four countries.
Arthritis Rheum 2008;58(9):2642-51.
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现实医疗环境下RA缓解率低是否可以用预测因素解释？
Loppin E, et al. ACR 2010. Present
No: 315.
目的：缓解是RA患者所能达到的最佳状态。日常临床工作中的缓解率低于随机临床试验。本研究旨在明确现实医疗环境下的临床缓解因素。
方法：回顾性评估364例接受常规诊疗的RA患者病历。这些患者为2008年在大学附属医院至少随诊1次的门诊和住院病人。根据病历进行DAS28评分以确定疾病活动度。临床缓解定义为DAS28<2.6。统计学分析采用SAS9软件中的卡方检验和多变量分析。
结果：共有328例患者（90%）进行疾病活动度评估，平均年龄63岁，平均病程13.6年。RF和抗CCP抗体的阳性率为79.3%和73.8%。85%患者具有侵蚀性病变。总体缓解率为28%。多变量分析中与临床缓解相关的因素为：男性（95%CI 0.2-0.8），年龄较小（0.2-0.9），RF阳性（1.2-6.5），不联用强的松（0.3-0.9）。年龄较小和RF阳性代表着“治疗目标更高”的人群，女性和年龄较大的患者在评估疾病时会有所差别，而非RA活动度的真实差别。此外，治疗不同，临床缓解率差别显著：15%未使用DMARDs或生物制剂，24%使用DMARDs，47%使用TNFα抑制剂。在三种TNFα抑制剂中，英夫利昔单抗的临床缓解率最低（18%），依那西普为43%，阿达木单抗最高（64%）。英夫利昔单抗与阿达木单抗差别显著（OR: 1.2-101），与依那西普差别显著（OR: 1.1-30.15），但依那西普与阿达木单抗之间没有显著性差异。
结论：男性、年龄较小、RF阳性和未使用糖皮质激素与临床缓解相关。在常规临床工作中评估临床缓解是可以实现的，依那西普和阿达木单抗的临床缓解率较高。
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