早期RA的缓解率—比较新缓解标准和与现有标准

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Prevalence of Remission in Early RA – A Comparison of New Remission Criteria to Established Criteria

 

 

Bindee Kuriya ¹, Ye Sun², Gilles Boire³, Boulos Haraoui⁴, Carol A. Hitchon⁵, Janet E. Pope⁶, J. Carter Thorne⁷, Edward Keystone², Diane S. Ferland⁸ and Vivian Bykerk⁹, ¹University of Toronto, Toronto, ON, ²Mount Sinai Hospital, Toronto, ON, ³CHUS - Sherbrooke University, Sherbrooke, QC, ⁴Institut de Rhumatologie, Montreal, QC, ⁵University of Manitoba, Winnipeg, MB, ⁶St. Joseph's Health Care, University of Western Ontario, London, ON, ⁷Newmarket, ON, ⁸LaSalle, QC, ⁹Brigham & Women's Hospital, Boston, MA

 

Presentation Number: 325

 

Background/Purpose: New RA remission (REM) criteria have been proposed by ACR/EULAR .We evaluated the prevalence and agreement between REM definitions in the Canadian Early ArThritis CoHort (CATCH).

Method: The % of patients (pts) in REM at 12 months based on 5 definitions were considered: DAS28 <2.6, DAS28 <2.0, CDAI </=2.8, SDAI </=3.3 and ACR/EULAR which requires TJC </=1 plus, SJC </=1, plus CRP </=1 mg/dL and patient global assessment (Pt-VAS) </=1 on a 0-10 cm VAS scale. Patients with complete data were included. Differences in core components for each REM definition were qualitatively described.  Kappa-statistics of agreement between criteria were performed.

Result: Of 331 pts, 74% met 1987 and 91% met 2010 ACR criteria for RA; 76% were female, mean (SD) age was 52 (14.4) years and mean (SD) symptom duration was 6.3 (3.0) months.  At baseline, the cohort had moderate-to-high disease activity according to all scores. Most were RF+ (63%) or anti-CCP+ (83%). Triple DMARD was the most common therapy. By 1 year, the % of pts who achieved REM by >/= 1 definition ranged from 22%-53% (Table).  Higher TJC, SJC, Pt-VAS and MD-VAS were seen for DAS28-based definitions.  Biologic use was similar for all definitions (range 6-10%). The ACR/EULAR criteria had substantial agreement with SDAI (k= 0.75) and CDAI (k=0.73). Agreement was fair with DAS28<2.6 (k=0.32) and DAS28<2.0 (k=0.35).

Conclusion: The prevalence of clinical REM ranged between 22 and 53% among this early RA cohort. Achievement of REM was lowest using the strict ACR/EULAR criteria and there was poor agreement between these criteria and frequently used DAS-based definitions. Thus, the choice of definition influences the proportion able to achieve REM and this has implications for long-term outcomes, choice of therapy and quality of care standards.

 

早期RA的缓解率—比较新缓解标准和与现有标准

 

Kuriya B, et al. ACR 2011. Present No: 325.

 

背景/目的: ACR/EULAR提出了新的RA缓解(REM)标准。我们对加拿大早期RA患者（CATCH）REM的比例及其一致性进行评价。

方法: 12个月时％患者(pts) REM的定义基于以下5项定义: DAS28< 2.6, DAS28< 2.0, CDAI< / = 2.8), SDAI < / = 3.3和 ACR/EULAR 缓解即TJC</ = 1, SJC < / = 1, CRP < / = 1mg/dl和病人的整体评价(Pt-VAS)< / = 1厘米（0-10视觉标尺）。资料完整的患者纳入本研究。 REM定义中每项核心指标的差异都计量表述。Kappa-分析检测不同标准间的一致性。

结果: 331例患者中,74%符合1987年RA标准, 91%符合2010标准,76%是女性,平均(SD)年龄为52 (14.4)岁,平均病程(标准差)为6.3(3.0)个月。根据所有积分系统, 基线水平时该组患者均为中到重度活动。大多数是RF阳性(63%)或anti-CCP 阳性(83%)。最常见的治疗为三联DMARD。随访1年时,按照> / = 1定义患者获得REM百分比为 22% - -53%不等(见表)。DAS28定义的缓解中SJC、Pt-VAS和MD-VAS数值较高。 生物制剂应用在不同定义中的结果相似 (范围6 - 10%)。ACR/EULAR标准与SDAI(k = 0.75), CDAI(k = 0.73)一致性较好。DAS< 2.6(k = 0.32)和DAS28< 2.0(k = 0.35)结果一致。

结论: 早期RA队列中获得临床REM的比例介于22和53%之间 。应用严格的ACR /EULAR标准, REM的达标率最低, 这一标准与我们的常用的基于DAS定义的标准符合率差 。因此,选择不同的缓解定义会影响REM达标的患者比率,从而影响到长期预后、治疗选择和护理标准的质量。

Table: Comparison of core components of remission definitions at 12 months.

	DAS28 <2.6	DAS28 <2.0	SDAI </=3.3	CDAI </=2.8	ACR/EULAR
Number i  REM, (%)	176 (53)	118 (36)	88 (27)	83 (25)	73 (22)
Core Components
TJC (%)   0-2   >2-5   >5	129 (73) 29 (16) 18 (11)	94 (80) 18 (15) 6 (6)	79 (90) 8 (9) 1 (1)	76 (92) 5 (6) 2 (2)	73 (100) 0 0
SJC (%)   0-2   >2-5   >5	129 (73) 36 (20) 11 (7)	97 (82) 20 (17) 1 (1)	83 (94) 4 (5) 1 (1)	79 (95) 4 (5) 0	73 (100) 0 0
CRP, mean ± SD mg/L	0.3 ± 0.4	0.3 ± 0.4	0.3 ± 0.3	0.4 ± 0.5	0.3 ± 0.2
Pt-VAS, mean ± SD mm	1.8 ± 2.2	1.8 ± 2.2	0.6 ± 0.8	0.5 ± 0.7	0.3 ± 0.4
MD-VAS, mean ± SD mm	0.8 ± 1.1	0.7 ± 1.0	0.2 ± 0.5	0.2 ± 0.3	0.3 ± 0.6