IMPROVED研究后续报道: 早期RA患者治疗4个月时MCP的骨密度减低预示1年时关节破坏进展

Wevers-de Boer KV, et al. AnnRheum Dis. 2015 Feb;74(2):341-6.

原文

Four-month metacarpalbone mineral density loss predicts radiological joint damage progression after1 year in patients with early rheumatoid arthritis: exploratory analyses fromthe IMPROVED study.

Aim: To assess whether in early(rheumatoid) arthritis (RA) patients, metacarpal bone mineral density (BMD)loss after 4 months predicts radiological progression after 1 year of antirheumatictreatment.

Methods: Metacarpal BMD was measured 4monthly during the first year by digital X-ray radiogrammetry(DXR-BMD) in patients participating in the IMPROVED study, a clinical trial in610 patients with recent onset RA (2010 criteria) or undifferentiatedarthritis, treated according to a remission (disease activity score<1.6)steered strategy. With Sharp/van der Heijde progression ≥0.5 points after 1 year(yes/no) as dependent variable, univariate and multivariate logistic regressionanalyses were performed.

Results: Of 428 patients with DXR-BMDresults and progression scores available, 28 (7%) had radiological progressionafter 1 year. Independent predictors for radiological progression were presenceof baseline erosions (OR (95% CI) 6.5 (1.7 to 25)) and early DXR-BMD loss (OR(95% CI) 1.5 (1.1 to 2.0)). In 366 (86%) patients without baseline erosions,early DXR-BMD loss was the only independent predictor of progression (OR (95%CI) 2.0 (1.4 to 2.9)).

Conclusions: In early RA patients,metacarpal BMD loss after 4 months of treatment is an independent predictor ofradiological progression after 1 year. In patients without baseline erosions,early metacarpal BMD loss is the main predictor of radiological progression.

译文

目的: 评估早期RA患者, 4个月时掌骨骨密度（BMD）减低是否预示1年时关节破坏进展。

方法: IMPROVED研究共纳入610例近期诊断的RA患者（2010分类标准）或未分化关节炎患者, 采用目标治疗策略进行治疗（DAS44< 1.6）。第一年, 每4个月用数字化X线片测量法（DXR-BMD）检测掌骨BMD。以1年后SHARP评分 ≥ 0.5（是/否）为应变量, 采用单因素和多因素逻辑回归分析。

结果: 428例患者基线和1年后的DXR-BMD结果和放射学摄片, 其中28例（7%）患者有放射学进展。放射学进展的独立预测因子为基线骨侵蚀(OR(95% CI) 6.5 (1.7 - 25))和早期BMD的降低(OR(95% CI) 1.5 (1.1 to 2.0))。366例（86% ）患者没有基线骨侵蚀, 早期BMD的降低为骨侵蚀进展的唯一、独立的风险预测因子(OR(95%CI) 2.0 (1.4 - 2.9))。

结论: 早期RA患者治疗4个月后掌骨骨密度降低, 是1年后影像学进展独立的预测因子。对于无基线骨侵蚀的患者, 早期掌骨骨密度降低是影像学进展的主要预测因子。