风湿

生物DMARD是类风湿关节炎放射学进展的保护因素

作者:Louveau B. et al 翻译:北医三院翟佳羽 来源:中国风湿病公众论坛 日期:2018-06-14
导读

         生物DMARD是类风湿关节炎放射学进展的保护因素

        摘要:目的:部分研究者考虑到暴露于治疗为二元变量(是/否),故尝试根据基线特征预测类风湿关节炎影像学进展的风险。考虑到基线特征及累积暴露于糖皮质激素或者DMARDs药物双方面的因素,这项研究的目的是对5年放射学进展风险建模。

        方法:这项研究包含403例符合类风湿关节炎1987年ACR标准或者2010年ACR/EULAR标准的患者,且有基线期及5年完整的影像学数据。放射学进展定义为5年患者的Sharp/Van der Heidje评分显著增加(最小可检测差异*5)。从以下几个方面选择最佳logistic回归模型:该模型仅包含临床生物学基线特征;将基线特征和治疗作为二元变量;以基线特征和治疗作为加权累积暴露变量。

        结果:143例患者(35.5%)出现放射学进展,最佳模型包含抗瓜氨酸多肽抗体阳性、ESR、肿胀关节数>14、基线侵蚀评分及糖皮质激素、MTX/LEF和生物DMARDs作为加权累积暴露变量。近期累积暴露于高剂量糖皮质激素(3月)与5年放射学进展风险显著相关,而36个月生物DMARDs治疗则为放射学进展的保护因素。

        结论:糖皮质激素和生物DMARDs在放射学进展中发挥重要作用。核算治疗级别和暴露强度是类风湿关节炎患者放射学进展预测模型的主要问题。

        附原文:OBJECTIVES: Several authors have tried to predict the risk of radiographic progression in RA according to baseline characteristics, considering exposure to treatment only as a binary variable (Treated:Yes/No). This study aims to model the risk of 5-year radiographic progression taking into account both baseline characteristics and the cumulative time-varying exposure to corticosteroids or DMARDs. METHODS: The study population consisted of 403 patients of the Etude et Suivi des Polyarthrites Indifférenciées Récentes cohort meeting the 1987 ACR or 2010 ACR/EULAR criteria for RA at inclusion and having complete radiographic data at baseline and 5 years. Radiographic progression was defined at 5 years as a significant increase of the Sharp/van der Heidje score (smallest detectable difference *5). The best logistic regression model was selected from the following: model including only clinico-biological baseline characteristics; model considering baseline characteristics and treatments as binary variables; and model considering baseline characteristics and treatments as weighted cumulative exposure variables. RESULTS: Radiographic progression occurred in 143 (35.5%) patients. The best model combined anti-citrullinated peptide antibody positivity, ESR, swollen joint count >14 and erosion score at baseline, as well as corticosteroids, MTX/LEF (MTX or LEF) and biologic DMARDs (bDMARDs) as weighted cumulative exposure variables. Recent cumulative exposure to high doses of corticosteroids (*3months) was significantly associated with the risk of 5-year radiographic progression and a significant protective association was highlighted for a 36-month exposure to bDMARDs.

        CONCLUSION:Corticosteroids and bDMARDs play an important role in radiographic progression. Accounting for treatment class and intensity of exposure is a major concern in predictive models of radiographic progression in RA patients.

        引自:Louveau B, De Rycke Y, Lafourcade A, et al. Effect of cumulative exposure to corticosteroid and DMARD on radiographic progression in rheumatoid arthritis: results from the ESPOIR cohort. Rheumatology (Oxford). 2018 May 22. doi: 10.1093/rheumatology/key122. [Epub ahead of print]

分享:

评论

我要跟帖
发表
回复 小鸭梨
发表

copyright©医学论坛网 版权所有,未经许可不得复制、转载或镜像 京ICP证120392号 京公网安备11010502031486号

京卫网审[2013]第0193号

互联网药品信息服务资格证书:(京)-经营性-2012-0005

//站内统计 //百度统计 //站长统计
*我要反馈: 姓    名: 邮    箱: