类风湿关节炎达标治疗相关影响因素的临床研究

黄玲玲; 徐建华; 徐胜前; 肖会; 常玲; 刘娜; 马芹

doi:10.16462/j.cnki.zhjbkz.2016.06.012

类风湿关节炎达标治疗相关影响因素的临床研究

doi: 10.16462/j.cnki.zhjbkz.2016.06.012

安徽医科大学第一附属医院风湿免疫科, 安徽合肥 230022

基金项目:

国家自然科学基金青年科学基金（81302587）

详细信息

作者简介:
黄玲玲(1989-),女,六安寿县人,在读硕士研究生。主要研究方向:类风湿关节炎。

中图分类号: R181.1;R539.22
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出版历程
- 收稿日期: 2015-12-04
- 修回日期: 2016-03-18

Treat-to-target of rheumatoid arthritis and potential determinants

Department of rheumatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

摘要

摘要: 目的调查类风湿关节炎患者（rheumatoid arthritis，RA）达标治疗情况，分析其影响因素，进一步提高RA达标治疗率。方法选择300例RA患者，详细记录所有患者临床资料，并根据28关节疾病活动性（disease activity score in 28 joints，DAS28）评分分为达标组和未达标组。结果 RA患者中，达标率为36.7%；达标组和未达标组比较：达标组比未达标组患者平均年龄轻、文化程度高、关节肿胀数/关节压痛数少、疼痛程度评分/患者总体评估/医师总体评估（physician global assessment,PGA）低；达标组持续使用致病情缓解抗风湿病药（disease-modifying anti-rheumatic drugs,DMARDs）单药或联合治疗时间≥3个月所占比例高于未达标组；达标患者类风湿因子、红细胞沉降率、C反应蛋白、关节功能分级、生活质量得分低于未达标患者；Logistic回归分析显示：关节功能分级、C反应蛋白、PGA是RA达标治疗独立影响因素。结论 RA患者达标治疗率仍较低，DMARDs正规治疗对达标治疗具有重要作用，关节功能、C反应蛋白、PGA为RA达标治疗独立影响因素。
- 关节炎, 类风湿 /
- Logistic 模型 /
- 危险因素
Abstract: Objective To investigate treat-to-target rate of rheumatoid arthritis (RA), analyse its potential determinants and to improve treat-to-target rate of RA. Methods 300 RA patients were recruited and clinical data were recorded detailedly. All 300 RA patients were devided into treat-to-target and not treat-to-target according to the disease activity score in 28 joints (DAS28). Results The treat-to-target rates of this study were 36.7%;RA patients who were treated-to-target had younger age, higher education, fewer swollen joint counts,fewer tender joint counts, lower visual analogue scale, lower patient global assessment, lower physician global assessment (PGA), lower rheumatoid factor, lower erythrocyte sedimentation rate, lower C-reactive protein level, lower joint function classification, lower health assessment questionnaire score and more regular treatment with disease-modifying anti-rheumatic drugs (≥3 months) when compared with those were not. Logistic regression analysis revealed that low PGA, low joint function classification and low C-reactive protein were independent determinants of treat-to-target. Conclusions The treat-to-target rate of RA patients was still low. Regular treatment with DMARDs was important to treat-to-target in RA. Low PGA, low C-reactive protein and low joint function classification were significant independent determinants for RA treat-to-target.
- Arthritis,rheumatoid /
- Logistic models /
- Risk factors

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参考文献(15)

Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs:2013 update [J]. Ann Rheum Dis, 2014,73:492-509.

Sokka T, Hetland ML, Mäkinen H, et al. Remission and rheumatoid arthritis: data on patients receiving usual care in twenty-four countries [J]. Arthritis Rheum, 2008,58(9):2642-2651.

Lutf A, Poil AR, Hammoudeh M. Characteristics of patients With rheumatoid arthritis in Qatar:a cross-sectional study [J]. Int J Rheum Dis, 2014,17(1):63-65.

Wang GY, Zhang SL, Wang XR, et al. Remission of rheumatoid arthritis and potential determinants: a national multi-center cross-sectional survey [J]. Clin Rheumatol, 2015,34(2):221-230.

邓雪蓉,周炜,王昱,等. 类风湿关节炎在不同治疗方案下的达标情况及影响因素分析 [J]. 中华风湿病学杂志, 2014,18(6):365-368.

Katchamart W, Johnson S, Lin HJ, et al. Predictors for remission in rheumatoid Arthritis patients:a systematic review [J]. Arthritis Care Res(Hoboken), 2010,62(8):1128-1143.

Ellerby N, Mattey DL, Packham J, et al. Obesity and comorbidity are independently associated with a failure to achieve remission in patients with established rheumatoid arthritis [J]. Ann Rheum Dis, 2014,73(11):e74.

Choy T, Bykerk VP, Boire G, et al. Physician global assessment at 3 months is strongly predictive of remission at 12 months in early rheumatoid arthritis: results from the CATCH cohort [J]. Rheumatology (Oxford), 2014,53(3):482-490.

Cannon GW, Wang BC, Park GS, et al. Remission in rheumatoid arthritis patients treated with etanercept monotherapy: clinical practice and clinical trial Experience [J]. Clin Exp Rheumatol, 2013,31(6):919-925.

van den Broek M, Dirven L, Klarenbeek NB, et al. The association of treatment response and joint damage with ACPA-status in recent-onset RA: a subanalysis of the 8-year follow-up of the BeSt study [J]. Ann Rheum Dis, 2012,71(2):245-248.

Ma MH, Scott IC, Dahanayake C, et al. Clinical and serological predictors of remission in rheumatoid arthritis are dependent on treatment regimen [J]. J Rheumatol, 2014,41(7):1298-1303.

Emery P, Hammoudeh M, Fitzgerald O, et al. Sustained remission with etanercept tapering in early rheumatoid arthritis [J]. N Engl J Med, 2014,371(19):1781-1792.

Emery P, Burmester GR, Bykerk VP, et al. Evaluating drug-free remission with abatacept in early rheumatoid arthritis: results from the phase 3b, multicentre, randomised, active-controlled AVERT study of 24 months, with a 12-month, double-blind treatment period [J]. Ann Rheum Dis, 2015,74(1):19-26.

Nakashima Y, Kondo M, Fukuda T, et al. Remission in patients with active rheumatoid arthritis by tocilizumab treatment in routine clinical practice: results from 3 years of prospectively registered data [J]. Mod Rheumatol, 2014,24(2):258-264.

Gossec L, Dougados M, Goupille P, et al. Prognostic factors for remission in early rheumatoid arthritis: a multiparameter prospective study [J]. Ann Rheum Dis, 2004,63(6):675-680.

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