来自风湿病研究院RA患者队列研究显示, RA日常诊治时特别是早期RA患者成功维持新ACR/EULAR缓解标准能获

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Successful Maintenance of Remission Defined by the New ACR/EULAR Criteria Leads to Better Functional Outcomes in RA in Daily Practice, Especially in Patients with Early RA, Based on the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) Cohort

Kumi Shidara, Eiichi Tanaka, Eisuke Inoue, Yohei Seto, Ayako Nakajima, Shigeki Momohara, Atsuo Taniguchi and Hisashi Yamanaka, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan

Presentation Number: 332

Background/Purpose: Remission has become a therapeutic target in the management of patients with rheumatoid arthritis (RA). New remission criteria were proposed by ACR/EULAR to achieve better patient outcomes in 2010. However, the clinical outcomes of RA patients in daily practice who satisfy the new criteria have not been well elucidated. To evaluate long-term functional outcomes in RA patients who satisfied the new ACR/EULAR or DAS28 remission criteria in daily practice based on a cohort of RA patients.

Method: We established a large observational cohort of RA patients, IORRA (Institute Of Rheumatology, Rheumatoid Arthritis) cohort, in our institute beginning in October 2000. Clinical parameters including physician’s assessment, patient’s assessment, and laboratory data are collected twice yearly (in April and October). Those RA patients who were in DAS28 remission in April 2008 (baseline) and who completed all IORRA assessments every 6 months from April 2008 to October 2010 (six data collections) were selected for this study. All patients were evaluated whether or not they achieved the ACR/EULAR or DAS28 remission criteria at every data collection. Functional disability was assessed by J-HAQ, the validated Japanese version of HAQ. Boolean trial, Boolean practice, SDAI remission, and CDAI remission were used as ACR/EULAR remission criteria. Among those patients, the percentages whose J-HAQ score progressed during the observation period were calculated.

Result: A total of 915 RA patients in DAS28 remission at baseline who completed all IORRA data collections in the succeeding 3 years were selected (females, 76.3%; mean age, 57.6 years; mean RA disease duration, 11.7 years; mean DAS28, 2.0; mean J-HAQ, 0.32). Percentages of patients whose J-HAQ progressed during the observation period among patients who had continuously achieved remission defined by Boolean trial, SDAI, Boolean practice, CDAI, and DAS28 in all six data collections were 6.2% (10/161), 8.5% (21/247), 5.7% (10/175), 7.1% (16/227), and 14.2% (45/318), respectively. In contrast, the percentages of patients whose J-HAQ progressed was higher among patients who did not fulfill the remission criteria continuously during the 3 years of observation. When patients satisfied the Boolean trial, SDAI, Boolean practice, CDAI, and DAS28 remission criteria in only one of the six data collections during the succeeding 3 years, percentages of patients whose J-HAQ score progressed were 30.8%, 47.4%, 31.7%, 47.1%, and 57.1%, respectively. This was more apparent in patients with a shorter duration of RA than in those with long-term disease.

Conclusion: Remission defined by the new ACR/EULAR resulted in better functional outcomes in RA patients compared to that of DAS28 remission in daily practice. However, maintenance of remission for a longer period of time is important for preventing patients from progression of disability as assessed by J-HAQ using any criteria of remission. This is more important in patients in earlier disease stages than patients with established disease. Thus, introduction and maintenance of remission in early-stage disease is recommended to achieve better functional outcomes in RA patients.

来自风湿病研究院RA患者队列研究显示, RA日常诊治时特别是早期RA患者成功维持新ACR/EULAR缓解标准能获得更好的功能结果

Shidara K, et al. ACR 2011. Present No: 332.

背景/目的: 缓解已成为类风湿性关节炎(RA)患者的治疗目标。为获得更好的预后, ACR/EULAR在2010年提出了更新的RA缓解标准。然而,日常实践中符合新标准的RA患者的临床结果并未得到很好的阐明。本研究评价了日常实践中符合新缓解标的RA患者的长期功能结果。

方法:我们建立了一个大型RA患者观察队列IORRA(风湿病研究院类风湿性关节炎), 始于2000年10月。每年两次(在4月和10月)收集临床指标包括医生评估、患者评估及实验室数据。本研究选择那些2008年4月达到DAS28缓解(基线)并完成2008年4月至2010年10月期间每6月一次的IORRA评估 (6次数据收集)的患者。每次数据收集时, 所有患者都评估是否达到了ACR /EULAR或DAS28缓解标准。功能障碍的评价采用J-HAQ(日语版的HAQ)。 用Boolean试验、Boolean实践, SDAI缓解和CDAI缓解评估ACR /EULAR缓解标准。计算随访期间 J-HAQ积分进展的患者百分比。

结果: 共纳入915例基线水平达到DAS28缓解并完成以后3年所有IORRA数据收集的RA 患者(女性,占76.3%,平均年龄57.6岁,平均RA病程11.7年,平均DAS28 评分2.0,平均J-HAQ积分0.32)。观察期间6次数据收集中持续达到Boolean试验、 SDAI、Boolean实践,CDAI和DAS28缓解而J-HAQ积分有进展的患者比例分别为6.2%(10/161)、8.5%(21/247)、5.7%(10/175)、7.1%(16/227)和14.2%(45/318) 。相比之下, 3年观察期间未达到缓解的患者中J-HAQ进展的比例明显增高。如果患者3年的6次数据收集时只有一次达到Boolean试验、 SDAI、Boolean实践,CDAI或DAS28缓解的患者中J-HAQ进展的比率分别为30.8%,47.4%,31.7%,47.1%和57.1%。 相比病程长的患者, 这个现象在病程短的患者更明显。

结论: 日常实践中新的ACR/EULAR缓解定义比DAS28能更好地提示RA患者的功能结局。然而,无论应用何种缓解标准, 对J-HAQ的评估都显示更长期的缓解是预防残疾的关键。 这对疾病早期的患者比长期患者显得更为重要。因此, 我们建议在疾病早期诱导和维持缓解能使RA患者获得较好的功能预后。