類風濕性關節炎的惡化率自1990年後減半


  【24drs.com】類風濕性關節炎(RA)的自然史自1990年後大幅改變,顯然是RA治療進步的結果,例如使用生物製劑和更積極的達標治療臨床方法。研究者在線上發表於3月8日風濕病學期刊的文獻指出,1990年後的長期惡化率研究發現,年度惡化率比25年前減少一半。
  
  英國Hatfield Hertfordshire大學風濕病學顧問Adam Young醫師等人檢視了1965-2014年間發表RA長期研究報告的年度惡化率,他們對28篇放射學惡化研究和41篇惡化預測研究進行系統性回顧與統合分析。
  
  在1990年前與1990年後納入的患者,他們在開始時的放射學分數相似。所有試驗中,在開始時, 放射學分數中位數是最大損傷的2.02%,1990年前納入的患者,放射學分數是2.01%、1990年後納入的患者,分數是2.03%。
  
  整體而言,研究者估計,年度惡化率是最大損傷的1.08%,不過,放射學關節損傷分數的年度惡化率,1990年後納入的患者的是0.68%、1990年前納入的患者是1.50%(P < .05)。
  
  根據作者指出,兩個納入期間的變化與臨床處置的改變一致,特別是更廣泛使用methotrexate做為描定疾病調節抗風濕藥物。
  
  作者們承認,無法評估治療的直接效果。儘管如此,從他們進行研究時,患者很可能接受了根據已發表之治療處方指引進行的標準當代照護。
  
  回顧時採用的主要預測因子是疾病期標記、類風濕因子陽性、抗環瓜氨酸胜肽抗體陽性。作者們寫道,目前,基因標記並未提供太多可臨床應用的預後資訊。
  
  研究者結論表示,放射學損傷的惡化自1990年後減半,或許是因為治療改善、類風濕因子/抗環瓜氨酸胜肽抗體陽性、以及急性期反應物的標記增加的結果,這些是放射學惡化的最強預測因子,或許可用於哪些RA患者的惡化風險比較高、哪些患者可以從早期積極治療獲益的初期確認。
  
  資料來源:http://www.24drs.com/
  
  Native link:Rheumatoid Arthritis Progression Rate Has Halved Since 1990

Rheumatoid Arthritis Progression Rate Has Halved Since 1990

By Janis C. Kelly
Medscape Medical News

The natural history of rheumatoid arthritis (RA) has changed dramatically since 1990, apparently as a result of advances in RA treatment, such as the use of biologicals and more aggressive "treat to target" clinical approaches. The annual progression rates in studies of long-term progression reported after 1990 were less than half those reported in the prior 25 years, researchers report in an article published online March 8 in Rheumatology.

Adam Young, MD, consultant rheumatologist, University of Hertfordshire, Hatfield, United Kingdom, and colleagues examined annual progression rates reported in long-term studies of RA published between 1965 and 2014. Their systematic review and meta-analysis of long-term cohorts included 28 studies of long-term radiographic progression and 41 studies of predictors of progression.

Baseline radiographic scores were similar in cohorts of patients recruited pre- and post-1990. At baseline, for all trials, the median baseline radiographic score was 2.02% of maximal damage. The baseline score for patients recruited before 1990 was 2.01% and for patients recruited after 1990 it was 2.03%.

Overall, the researchers estimated an annual rate of progression of 1.08% of maximum damage. However, the annual rate for progression of radiographic joint damage scores was 0.68% in the post-1990 cohorts vs 1.50% in the pre-1990 cohorts (P < .05).

According to the authors, differences between the two recruitment periods coincide with changes in clinical management, particularly more intensive use of methotrexate as an anchor disease-modifying antirheumatic drug.

The authors acknowledge not being able to assess the direct effect of treatment. "Nevertheless, it is likely patients received standard contemporary care based on published guidelines about treatment regimens from the time they were being studied," they write.

The main predictive factors identified in the review were acute phase markers, rheumatoid factor positivity, and anti–cyclic citrullinated peptide antibody positivity. The authors write, "Currently, genetic markers do not provide much additional prognostic information that can be applied clinically."

The researchers conclude that the progression of radiographic damage has halved since 1990, probably as a result of improved treatment, and that rheumatoid factor/anti–cyclic citrullinated peptide antibody positivity, along with increased markers of acute phase reactants, are the strongest predictors of radiographic progression, possibly useful for early identification of patients with RA who are at higher risk for progression and who might benefit from early, aggressive treatment.

The study was supported by the UK National Institute for Health Research. The authors have disclosed no relevant financial relationships.

Rheumatology. Published online March 8, 2016.

    
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