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首页> 外文期刊>BMC Rheumatology >Radiographic progression in early rheumatoid arthritis patients following initial combination versus step-up treat-to-target therapy in daily clinical practice: results from the DREAM registry
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Radiographic progression in early rheumatoid arthritis patients following initial combination versus step-up treat-to-target therapy in daily clinical practice: results from the DREAM registry

机译：在日常临床实践中，初次联合使用类风湿关节炎患者后的放射学进展与逐步加靶治疗相比：DREAM注册中心的结果

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Early and intensive targeted treatment with disease modifying anti-rheumatic drugs (DMARDs) has been shown to lead to substantial reductions in disease activity and radiograph damage in patients with early rheumatoid arthritis (RA). The aim of this quasi-experimental study was to compare the first-year radiographic progression rates between a treat-to-target (T2 T) strategy with initial combination therapy (strategy II, started in 2012) versus an initial step-up monotherapy (strategy I, started in 2006). A total of 128 patients from strategy II was individually matched with 128 patients from strategy I on sex, age (± 5 yrs.) and baseline disease activity (± 0.5 on the DAS28). Differences in radiographic progression (Sharp/van der Heijde) scores (SHS) and the number of patients experiencing a minimal clinically important difference (MCID; ≥ 5 SHS points) between both strategies were tested with Mann Whitney U and chi-square tests. Next, linear and logistic regression analyses were performed to examine which baseline variables were associated with radiographic progression scores and the probability of experiencing an MCID within 1 year. Patients with initial combination therapy had slightly higher baseline disease activity scores and pain scores, but better mental health scores. Patients with initial monotherapy had significantly more, and more frequently clinically relevant, radiographic progression after 1 year. Experiencing a MCID was independently associated with fewer tender joints (p = 0.050) and higher erythrocyte sedimentation rate (p = 0.015) at baseline. Treating early RA patients with initial combination therapy results in better radiographic outcomes than initial monotherapy in daily clinical practice. Netherlands Trial Register NTR578 , 12 January 2006.
机译：研究表明，早期使用抗风湿药（DMARDs）进行的针对性强的靶向治疗可导致风湿性关节炎（RA）早期患者的疾病活动和X线片损伤显着降低。这项准实验研究的目的是比较初始联合疗法（策略II，于2012年开始）与初始逐步单一疗法（T2T）策略之间的第一年放射学进展率（T2T）策略I，始于2006年）。在性别，年龄（±5岁）和基线疾病活动（在DAS28上为±0.5）上，策略II的总共128名患者与策略I的128名患者分别匹配。使用曼恩·惠特尼（Mann Whitney U）和卡方检验测试了两种策略之间的放射学进展差异（Sharp / van der Heijde）得分（SHS）和经历最小临床上重要差异（MCID;≥5 SHS点）的患者人数。接下来，进行线性和逻辑回归分析，以检查哪些基线变量与影像学进展分数相关，以及在1年内经历MCID的可能性。最初联合治疗的患者的基线疾病活动评分和疼痛评分略高，但心理健康评分更高。最初接受单一疗法的患者在1年后的影像学进展明显更多，并且在临床上更为频繁。在基线时，经历MCID与嫩关节较少（p = 0.050）和较高的红细胞沉降率（p = 0.015）独立相关。在日常临床实践中，采用初始联合疗法治疗早期RA患者比最初的单一疗法具有更好的放射学结果。荷兰审判登记簿NTR578，2006年1月12日。

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