Effectiveness of initial treatment allocation based on expert opinion for prevention of rapid radiographic progression in daily practice of an early RA cohort

被引：23

作者：

Durnez, Anne ^{[1
]}

Vanderschueren, Geert ^{[2
]}

Lateur, Luc ^{[2
]}

Westhovens, Rene ^{[1
]}

Verschueren, Patrick ^{[1
]}

机构：

[1] Univ Hosp Leuven, Dept Rheumatol, B-3000 Louvain, Belgium

[2] Univ Hosp Leuven, Dept Radiol, B-3000 Louvain, Belgium

来源：

ANNALS OF THE RHEUMATIC DISEASES | 2011年 / 70卷 / 04期

关键词：

EARLY RHEUMATOID-ARTHRITIS; COMBINATION THERAPY; TREATMENT STRATEGIES; RANDOMIZED-TRIAL; JOINT DAMAGE; DOUBLE-BLIND; RISK MODEL; FOLLOW-UP; METHOTREXATE; MONOTHERAPY;

D O I：

10.1136/ard.2010.135319

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives To evaluate expert treatment selection for early rheumatoid arthritis and to validate a prediction model for rapid radiographic progression (RRP) in daily practice. Methods Patients received initial combination therapy with steroids (ICTS) or disease-modifying antirheumatic drug monotherapy (IMT) after informal evaluation of prognostic factors, followed by a tight control strategy. Changes in Sharp/van der Heijde score (total Sharp score (TSS)) of > 5 units over 1 year (=RRP) were documented. The mean change in TSS and proportion with RRP were compared between groups. Based on the 28 swollen joint count, rheumatoid factor titre and C reactive protein/erythrocyte sedimentation rate, patients were placed in the ASPIRE prediction matrix, yielding a RRP risk. Numbers needed to treat (NNT) intensively to avoid one RRP after 1 year were calculated. Results The mean change in TSS after 1 year and the proportion with RRP was lower in the ICTS group (n=37) than in the IMT group (n=43). The mean calculated risk of RRP was higher in patients with radiographic progression. The mean NNT intensively to prevent RRP was lower in the ICTS group than in the IMT group. The positive predictive value of NNT for RRP prevention was 12.6%, but the negative predictive value reached 100%. Conclusion ICTS seems more effective in preventing RRP than IMT. The predictive matrix model could be helpful in preventing overtreatment in practice.

引用

页码：634 / 637

页数：4

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