标签：eular文摘; 超声评估; 病情预测
超声对已获临床低活动度RA患者病情复发的预测
Lamers-Karnebeek FBG, et al. EULAR 2015.Present ID: OP0181.
背景:有相当数量的类风湿关节炎(RA)患者接受TNF拮抗剂(TNFi)治疗而获得低度疾病活动度(LDA),但应注意到该治疗会引致严重不良事件,费用也昂贵。所以,一旦患者达到LDA,停药是权宜之计,尤其是在能够预测病情复发的条件下。既往有少数研究提示超声检查关节似乎有预测复发的作用。
荷兰POET研究(Potential Optimalisation of Expediency of TNFi)是一项多中心、随机、前瞻性队列研究,旨在探究经TNFi诱导获得LDA的RA患者是否能停用TNFi。患者将随机分为继续应用或停用TNFi。本文报道的是POET研究的子项目POET-US。
目的:针对经TNFi诱导获得LDA的RA患者行超声检查是否能预测未来病情复发。
方法: POET研究中TNFi停用者纳入本次分析。这些患者符合ACR1987分类标准, LDA(DAS28<3.2)持续持续时间超过6个月,由于传统DMARD疗效不佳而转用TNFi治疗已超过1年,近6个月内未调整过药物剂量。19名经培训的超声操作者在研究基线对患者行超声检查,包括20个关节(双侧第1至第5 MCP掌背侧,双腕,双侧第2至第5 MTP背侧)。灰阶超声(GS)评估为0-3分,多普勒超声(PD)评估为0-3分。超声关节炎的定义: GS>1和/或PD>0。患者的临床随访频率为3个月一次以及怀疑病情的任何时候。病情复发的定义: DAS28>3.2且DAS28自基线加重>0.6。采用COX回归分析比较停用TNFi时有和无超声关节炎的患者的复发情况。
结果: 248例患者有9个月的临床数据。失访率为21%,在末次随访时作为截尾处理。高龄、长病程、抗CCP和IgM-RF阳性均与病情复发有关联。与没有超声关节炎者相比,至少有一个关节有超声关节炎的患者有更高的病情复发分析(HR: 1.77, 95%CI: 1.16-2.70),病情无复发的周期更短(请参见图)。表格显示9个月随访中复发和无复发患者在本研究基线时的临床和超声参数特征。
结论: 在组间水平,针对获得LDA并停用TNFi的患者,超声能预测这些患者未来是否会病情复发。
原文链接或参见以下信息。
- Oral Presentations
OP0181 Ultrasonography as Predictor for Flare in Rheumatoid Arthritis Patients with Low Disease Activity: Nine Month Results from Poet-Us-Study
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Author Affiliations
- 1Rheumatology, Radboud university medical center, Nijmegen
- 2Rheumatology, Viecuri medisch centrum, Venlo
- 3Rheumatology, Erasmus medical center, Rotterdam
- 4Rheumatology, University medical center Utrecht, Utrecht, Netherlands
Abstract
Background A significant number of rheumatoid arthritis (RA) patients can reach low disease activity (LDA) by using TNF-inhibitors (TNF-i), but this therapy can cause serious side-effects and is expensive. Therefore it could be expedient to stop in case of LDA, especially if relapse can be predicted. Ultrasonography of joints seems to be a predictor in this respect in smaller studies.
The Dutch POET (Potential Optimalisation of Expediency of TNF-i (TNF-inhibitor)) study, is a multicenter randomized prospective cohort study investigating if in patients with RA with LDA on TNF-i and conventional DMARD, the TNF-i can be stopped. Patients were randomized to continue or stop TNF-i. Part of this study is the POET-ultrasonography (US) study.
Objectives To investigate whether US at the time of stopping TNF-i in RA patients with LDA can predict future flare.
Methods Data of patients who stopped TNF-i in the POET study were used for this analysis. Participating patients had RA according to ACR 1987 criteria, >6 months a DAS28 <3.2 (LDA) and treatment with TNF-i > one year next to a conventional DMARD, without dose change in the past six months. Nineteen trained ultrasonographers performed US at baseline of the study, using different US machines, of 20 joints (bilaterally: MCP 1-5 dorsal and volar, wrists and MTP 2-5 dorsal aspect). The joints were graded on grayscale (GS; 0-3) and power doppler (PD; 0-3). US signs of arthritis were defined as GS>1 and/or PD>0. Trial visits were performed every 3 months and when flare was suspected. Flare was defined as DAS28>3.2 and at least >0.6 increase compared to the DAS28 at inclusion. Cox regression was performed to compare TNF-i free LDA between patients with versus those without US signs of arthritis ().
Results Nine months data were available for 248 patients. Twenty-one percent was lost to follow-up and censored at last observation. Higher age, longer disease duration, anti-CCP and IgM-RF positivity were all related to flare occurrence. Patients with US signs of arthritis in one or more joints had a greater risk of flare (HR 1.77; 95% CI of 1.16 to 2.70) and shorter relapse-free period compared to patients without US signs of arthritis (see ). The shows patient- and US-characteristics at inclusion for patients without flare within 9 months versus patients with flare.
Conclusions On the group level, US can predict flare in RA patients with LDA in whom TNF-i is stopped.
Disclosure of Interest F. Lamers-Karnebeek Grant/research support from: Abbvie, T. Jansen: None declared, P. van Riel: None declared, J. Luime: None declared, J. Jacobs: None declared