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首页> 外文期刊>Arthritis and Rheumatism >Implementation of a treat-to-target strategy in very early rheumatoid arthritis: results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study.
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Implementation of a treat-to-target strategy in very early rheumatoid arthritis: results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study.

机译：在非常早期的类风湿关节炎中实施以治疗为目标的策略：荷兰类风湿关节炎监测缓解诱导队列研究的结果。

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OBJECTIVE: Clinical remission is the ultimate therapeutic goal in rheumatoid arthritis (RA). Although clinical trials have proven this to be a realistic goal, the concept of targeting at remission has not yet been implemented. The objective of this study was to develop, implement, and evaluate a treat-to-target strategy aimed at achieving remission in very early RA in daily clinical practice. METHODS: Five hundred thirty-four patients with a clinical diagnosis of very early RA were included in the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Treatment adjustments were based on the Disease Activity Score in 28 joints (DAS28), aiming at a DAS28 of <2.6 (methotrexate, followed by the addition of sulfasalazine, and exchange of sulfasalazine with biologic agents in case of persistent disease activity). The primary outcome was disease activity after 6 months and 12 months of followup, according to the DAS28, the European League Against Rheumatism (EULAR) response criteria, and the modified American College of Rheumatology (ACR) remission criteria. Secondary outcomes were time to first DAS28 remission and outcome of radiography. RESULTS: Six-month and 12-month followup data were available for 491 and 389 patients, respectively. At 6 months, 47.0% of patients achieved DAS28 remission, 57.6% had a good EULAR response, and 32.0% satisfied the ACR remission criteria. At 12 months, 58.1% of patients achieved DAS28 remission, 67.9% had a good EULAR response, and 46.4% achieved ACR remission. The median time to first remission was 25.3 weeks (interquartile range 13.0-52.0). The majority of patients did not have clinically relevant radiographic progression after 1 year. CONCLUSION: The successful implementation of this treat-to-target strategy aiming at remission demonstrated that achieving remission in daily clinical practice is a realistic goal.
机译：目的：临床缓解是类风湿关节炎（RA）的最终治疗目标。尽管临床试验已证明这是一个现实的目标，但针对缓解的概念尚未实现。这项研究的目的是开发，实施和评估一种针对目标的策略，旨在在日常临床实践中在非常早的RA中实现缓解。方法：荷兰风湿性关节炎监测缓解诱导队列研究纳入了534例临床诊断为RA很早的患者。根据28个关节的疾病活动评分（DAS28）进行治疗调整，目标是DAS28 <2.6（甲氨蝶呤，然后加入柳氮磺吡啶，并在疾病持续存在的情况下与生物制剂交换柳氮磺胺吡啶）。根据DAS28，欧洲抗风湿病联盟（EULAR）响应标准和修改后的美国风湿病学院（ACR）缓解标准，主要结果是随访6个月和12个月后的疾病活动。次要结果是首次DAS28缓解的时间和X线摄影的结果。结果：分别有491名和389名患者的6个月和12个月随访数据。在6个月时，达到DAS28缓解的患者为47.0％，具有良好的EULAR反应的患者为57.6％，满足ACR缓解标准的患者为32.0％。在12个月时，有58.1％的患者达到了DAS28缓解，67.9％的患者具有良好的EULAR反应，46.4％的患者达到了ACR缓解。首次缓解的中位时间为25.3周（四分位间距13.0-52.0）。大多数患者在1年后没有临床相关的影像学进展。结论：成功实施了以缓解为目标的“以治疗为目标”的策略，表明在日常临床实践中实现缓解是一个现实的目标。

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