能否预测类风湿关节炎的持续缓解(转载自丁香园）

骞骞蔷薇

背景/目的：目前类风湿关节炎（RA）的治疗目标是达到临床缓解，以减少关节损伤和残疾，并维持或改善生活质量。持续缓解是实现这些目标的关键。RA持续缓解的预测因素尚不明确。本研究目的是确定持续缓解的预后因素并建立一个预测模型。

方法：应用日本全国的队列数据库（NinJa：日本风湿性疾病国家数据库）2009－2010的RA患者数据来评价基线特征、治疗情况，以及后续的临床结果：压痛关节数（TJC）、肿胀关节数（SJC）、C反应蛋白（C RP）、ESR、病人的视觉模拟评分（VAS）、医生的VAS、和改良的健康评估问卷（mHAQ）。所有2009年达到SDAI缓解的患者会根据2010年是否维持缓解分组。应用多元回归模型，计算预测因素和建立预后预测模型。自举法被用于内部模型验证。

结果： 2009年队列中4215例RA患者有930例获得SDAI缓解，623例（67%）1年后持续缓解。与非持续缓解组相比，持续缓解组的病程、SJI、CRP、ESR，病人VAS、医生VAS、和MHAQ都要显著降低（p< 0.05）。持续缓解组平均SDAI评分为1.45±0.92, 非持续缓解组为2.08±0.86在（p< 0.05）。总积分为6的预后预测模型建立如下：MHAQ > 1为2分；SJC> 1、ESR＞20、病人VAS> 0.5和医生VAS>0.5每项均为1分。这一模型ROC曲线下面积 是68.8%（95% CI：65-73%）。预测因素的自举法验证beta系数，与原始队列数据相同。

结论：我们发现1年后持续缓解的RA患者，其病程、SJC、CRP、ESR、病人VAS和医生VAS、MHAQ都明显低于未持续缓解者。应用临床相关的指标成功建立了一个预测模型并得到验证。
原文：
Can Sustained Remission of Rheumatoid Arthritis Be Predicted? an Analysis From the Japanese National Database of Rheumatic Disease (NinJa)

Abstract#: 399
Presenter: Yoichiro Haji: St. Luke's International Hospital
Date: Sunday, November 11
Time: 9:00 AM - 6:00 PM

Background/Purpose: Achievement of clinical remission in rheumatoid arthritis (RA) is now the goal of therapy to reduce joint damage and disability, and maintain or improve quality of life. Sustained remission is critical to attain these outcomes. Predictive factors for sustained remission of RA are not known. The purpose of this study is to identify prognostic factors of sustained remission and build a predictive model.

Methods: Data from RA patients registered in a nationwide Japanese cohort database (NinJa : National Database of Rheumatic Diseases by iR-net in Japan) in 2009 and 2010 were used to evaluate baseline characteristics, treatment profiles, and the following clinical outcomes: tender joint count (TJC), swollen joint count (SJC), C-reactive protein (CRP), ESR, patient Visual analog scale (VAS), physician VAS, and Modified Health Assessment Questionnaire (MHAQ). All patients with SDAI remission in 2009 were divided based on whether remission was maintained in 2010. A multivariate Cox regression model was constructed for predictive factors and a prognostic prediction model was constructed. Bootstrapping was used for internal model validation.

Results: Out of 4215 patients with RA in the 2009 cohort, 930 patients had SDAI remission, and 623 patients (67.0%) had sustained remission after 1 year. Compared to non-sustained remission group, duration of disease, SJC, CRP, ESR, patient VAS, physician VAS, and MHAQ were significantly lower in the sustained remission group (p<0.05). Mean SDAI score in the sustained remission group was 1.45 ± 0.92 versus 2.08 ± 0.86 in the non-sustained remission group (p<0.05). A prognostic prediction model with a total score of 6 points was constructed as follows: 2 points for MHAQ >1; 1 point each for SJC >1, ESR >20, patient VAS >0.5, and physician VAS >0.5. Area under the receiver operating characteristic (ROC) curve for this model was 68.8% (95% CI: 65.0-73.0%). Bootstrapped validation beta coefficients of predictors were identical to the original cohort data.

Conclusion: We found that duration of disease, SJC, CRP, ESR, patient VAS, physician VAS, and MHAQ are significantly lower in those with sustained remission after 1 year. A prediction model was successfully built and validated using clinically relevant parameters.