新近起病的活动性RA患者中达标治疗与常规治疗的疗效比较：来自GUEPARD试验和ESPOIR队列的数据

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Ann Rheum Dis doi:10.1136/ard.2010.137695 Disease activity score-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis: data from the GUEPARD trial and ESPOIR cohort   1.       M Soubrier1, 2.       C Lukas2, 3.       J Sibilia3, 4.       B Fautrel4, 5.       F Roux5, 6.       L Gossec6, 7.       S Patternotte6, 8.       M Dougados6 + Author Affiliations 1.       1Department of Rheumatology, Hôpital G Montpied, Clermont-Ferrand, France 2.       2Department of Rheumatology, Hôpital Lapeyronie, Montpellier, France 3.       3Department of Rheumatology, Hôpital Hautepierre, Strasbourg, France 4.       4Department of Rheumatology, Hôpital la Pitié Salpétrière, Paris, France 5.       5Department of Biostatistics, RCTs, Lyon, France 6.       6Department of Rheumatology B, Hôpital Cochin, Paris, France Abstract Objectives To compare the efficacy of disease activity score in 28 joints (DAS28ESR)-driven therapy with anti-tumour necrosis factor (patients from the GUEPARD trial) and routine care in patients with recent-onset rheumatoid arthritis (patients of the ESPOIR cohort). Results After matching GUEPARD and ESPOIR patients on the basis of a propensity score and a 1:2 ratio, at baseline all patients had comparable demographic characteristics, rheumatoid factor, anticyclic citrullinated peptide antibody positivity and clinical disease activity parameters: erythrocyte sedimentation rate, C-reactive protein, mean DAS (6.26±0.87), Sharp/van der Heijde radiographic score (SHS), health assessment questionnaire (HAQ). Disease duration was longer in GUEPARD patients (5.6±4.6 vs 3.5±2.0 months, p<0.001). After 1 year, the percentage of patients in remission with an HAQ (<0.5) and an absence of radiological progression was higher in the tight control group (32.3% vs 10.2%, p=0.011) as well as the percentage of patients in low DAS with an HAQ (<0.5) and an absence of radiological progression (36.1% vs 18.9%, p=0.045). However, there was no difference in the decrease in DAS, nor in the percentage of EULAR (good and moderate), ACR20, ACR50 and ACR70 responses. More patients in the tight control group had an HAQ below 0.5 (70.2% vs 45.2%, p=0.005). Overall, pain, patient and physician assessment and fatigue decreased more in the tight control group. The mean SHS progression was similar in the two groups as was the percentage of patients without progression. Conclusions In patients with recent onset active rheumatoid arthritis, a tight control of disease activity allows more patients to achieve remission without disability and radiographic progression.

新近起病的活动性RA患者中达标治疗与常规治疗的疗效比较：来自GUEPARD试验和ESPOIR队列的数据 M Soubrier1, et al.Ann Rheum Dis doi:10.1136/ard.2010.137695   目的：在新近起病的RA患者中，比较使用TNF抑制剂的DAS28达标治疗（GUEPARD试验患者）和常规治疗（ESPOIR队列患者）的疗效。   结果：根据倾向分数对GUEPARD和ESPOIR患者进行匹配，比例为1:2，所有患者的基线期人口学特征、类风湿因子、抗CCP抗体阳性和临床疾病活动度参数（ESR、CRP、平均DAS[6.26±0.87]、Sharp/van der Heijde影像学评分[SHS]、HAQ）均具有可比性。GUEPARD患者病程更长（5.6±4.6 vs 3.5±2.0 月，p<0.001）。1年后，达标治疗组中HAQ<0.5、没有影像学进展的缓解患者比例更高（32.3% vs 10.2%, p=0.011），HAQ<0.5、没有影像学进展的低DAS患者比例也更高（36.1% vs 18.9%, p=0.045）。但两组间DAS降低程度、EULAR反应良好和中等以及ACR20、ACR50、ACR70的患者比例没有差别。达标治疗组中HAQ<0.5的患者更多（70.2% vs 45.2%, p=0.005），疼痛、患者和医生评分、疲劳好转更为明显。两组间平均SHS进展和无进展的患者比例基本相同。   结论：在新近起病的RA患者中，达标治疗能使更多患者达到缓解，没有残疾和影像学进展。