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Bindee Kuriya 1, Ye Sun2, Gilles Boire3, Boulos Haraoui4, Carol A. Hitchon5, Janet E. Pope6, J. Carter Thorne7, Edward Keystone2, Diane S. Ferland8 and Vivian Bykerk9, 1University of Toronto, Toronto, ON, 2Mount Sinai Hospital, Toronto, ON, 3CHUS - Sherbrooke University, Sherbrooke, QC, 4Institut de Rhumatologie, Montreal, QC, 5University of Manitoba, Winnipeg, MB, 6St. Joseph's Health Care, University of Western Ontario, London, ON, 7Newmarket, ON, 8LaSalle, QC, 9Brigham & Women's Hospital, Boston, MA
Presentation Number: 325
Background/Purpose: New RA remission (REM) criteria have been proposed by ACR/EULAR .We evaluated the prevalence and agreement between REM definitions in the Canadian Early ArThritis CoHort (CATCH). Method: The % of patients (pts) in REM at 12 months based on 5 definitions were considered: DAS28 <2.6, DAS28 <2.0, CDAI </=2.8, SDAI </=3.3 and ACR/EULAR which requires TJC </=1 plus, SJC </=1, plus CRP </=1 mg/dL and patient global assessment (Pt-VAS) </=1 on a 0-10 cm VAS scale. Patients with complete data were included. Differences in core components for each REM definition were qualitatively described. Kappa-statistics of agreement between criteria were performed. Result: Of 331 pts, 74% met 1987 and 91% met 2010 ACR criteria for RA; 76% were female, mean (SD) age was 52 (14.4) years and mean (SD) symptom duration was 6.3 (3.0) months. At baseline, the cohort had moderate-to-high disease activity according to all scores. Most were RF+ (63%) or anti-CCP+ (83%). Triple DMARD was the most common therapy. By 1 year, the % of pts who achieved REM by >/= 1 definition ranged from 22%-53% (Table). Higher TJC, SJC, Pt-VAS and MD-VAS were seen for DAS28-based definitions. Biologic use was similar for all definitions (range 6-10%). The ACR/EULAR criteria had substantial agreement with SDAI (k= 0.75) and CDAI (k=0.73). Agreement was fair with DAS28<2.6 (k=0.32) and DAS28<2.0 (k=0.35). Conclusion: The prevalence of clinical REM ranged between 22 and 53% among this early RA cohort. Achievement of REM was lowest using the strict ACR/EULAR criteria and there was poor agreement between these criteria and frequently used DAS-based definitions. Thus, the choice of definition influences the proportion able to achieve REM and this has implications for long-term outcomes, choice of therapy and quality of care standards.
| 早期RA的缓解率—比较新缓解标准和与现有标准
Kuriya B, et al. ACR 2011. Present No: 325.
背景/目的: ACR/EULAR提出了新的RA缓解(REM)标准。我们对加拿大早期RA患者（CATCH）REM的比例及其一致性进行评价。 方法: 12个月时％患者(pts) REM的定义基于以下5项定义: DAS28< 2.6, DAS28< 2.0, CDAI< / = 2.8), SDAI < / = 3.3和 ACR/EULAR 缓解即TJC</ = 1, SJC < / = 1, CRP < / = 1mg/dl和病人的整体评价(Pt-VAS)< / = 1厘米（0-10视觉标尺）。资料完整的患者纳入本研究。 REM定义中每项核心指标的差异都计量表述。Kappa-分析检测不同标准间的一致性。 结果: 331例患者中,74%符合1987年RA标准, 91%符合2010标准,76%是女性,平均(SD)年龄为52 (14.4)岁,平均病程(标准差)为6.3(3.0)个月。根据所有积分系统, 基线水平时该组患者均为中到重度活动。大多数是RF阳性(63%)或anti-CCP 阳性(83%)。最常见的治疗为三联DMARD。随访1年时,按照> / = 1定义患者获得REM百分比为 22% - -53%不等(见表)。DAS28定义的缓解中SJC、Pt-VAS和MD-VAS数值较高。 生物制剂应用在不同定义中的结果相似 (范围6 - 10%)。ACR/EULAR标准与SDAI(k = 0.75), CDAI(k = 0.73)一致性较好。DAS< 2.6(k = 0.32)和DAS28< 2.0(k = 0.35)结果一致。 结论: 早期RA队列中获得临床REM的比例介于22和53%之间 。应用严格的ACR /EULAR标准, REM的达标率最低, 这一标准与我们的常用的基于DAS定义的标准符合率差 。因此,选择不同的缓解定义会影响REM达标的患者比率,从而影响到长期预后、治疗选择和护理标准的质量。 | ||||||||||||||||||||||||||||||||||||||||||||||||
| Table: Comparison of core components of remission definitions at 12 months.
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