摘要

        目的：比較阿達木單抗(ADA)對處於短期或長期疾病持續狀態的銀屑病關節炎(PsA)患者的治療效果，並評估合並常規合成的慢作用緩解疾病的抗風濕藥物(csDMARD)或糖皮質激素的療效。

        方法：納入2008年6月至2016年6月期間葡萄牙語注冊登記在風濕性疾病(Reuma.pt)的成年PsA患者，並接受ADA治療≥3個月。比較病程小於5年(早期PsA)和病程大於等於5年(晚期PsA)患者疼痛和腫脹關節計數，炎症參數，患者(PtGA)和醫師整體(PhGA)評估，DAS28評分以及健康評估問卷殘疾指數(HAQ-DI)的差別。應用Kaplan-Meier方法進行分析。

        結果：在應用ADA治療的135名PsA患者中，126名具有疾病持續時間的信息(早期PsA患者41名)。PsA患者應用ADA後疾病緩解率在3個月後達到72.9%(早期PsA為88.0%，晚期PsA為62.2%，P = 0.022)，24個月後為85.4%(早期PsA為100%，晚期PsA為75.9%，P =0.044)。早期PsA患者的關節疼痛明顯減輕(2.7 vs. 6.7，p = 0.006)，平均C-反應蛋白(0.5mg / dL vs. 1.3mg / dL; P = 0.011)和PhGA(18.3 vs. 28.1; P = 0.020)。從長期來看，早期PsA患者關節腫脹較少(0.3 vs. 1.7; P = 0.030)，PhGA較低(6.3 vs. 21.9; P <0.001)，C-反應蛋白較低(0.4mg / dL vs. 1.0mg / dL; P =0.026)和DAS28評分亦較低(2.2 vs.3.2; P= 0.030)。經治療後早期PsA患者和晚期PsA患者HAQ-DI均減低，分別達到平均值0.4和0.8。早期PsA患者獲得PsARC反應比晚期PsA更快(分別為3.8和7.4個月; P = 0.008)。同時應用csDMARDs臨床獲益更多(2年PsARC反應，88.3% vs. 60.0%; P = 0.044)。但同時應用糖皮質激素在2年的隨訪期間對PsARC應答沒有影響。兩組患者ADA應用情況相似。

        結論：早期PsA患者在ADA治療後獲得改善的機會更大，關節功能恢複情況更好，並且比晚期PsA更快地獲得PsARC應答。在這項隊列研究中，應用csDMARDs超過2年是有臨床獲益的。

        附原文：

        Objective:To compare outcomes in psoriaticarthritis (PsA) patients initating adalimumab (ADA), with short-and long-termdisease duration and to evaluate the potential effect of concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or glucocorticoids.

        Methods:Analyses included adult PsA patients registered in the RheumaticDisease Portuguese Register (Reuma.pt) between June 2008-June 2016 who receivedADA for ≥3 months. Psoriatic ArthritisResponse Criteria (PsARC) response, tender and swollen joint count,inflammatory parameters, patient (PtGA) and physician global assessment (PhGA),Disease Activity Score-28 joints (DAS28), and Health Assessment Questionnaire DisabilityIndex (HAQ-DI) were compared between patients with < 5years of disease (early PsA) and those with ≥ 5 yearsof disease duration (late PsA). Timing to achieving PsARC response wasestimated using the Kaplan-Meier method.

        Results:Of 135 PsA patients treatedwith ADA, 126 had information on disease duration (early PsA, n=41). PsARC response was achieved by 72.9% of the patients (88.0% early PsA vs. 62.2% latePsA; P=0.022) after 3 months and by 85.4% after 24 months (100% early PsA vs.75.9% late PsA; P=0.044). Early PsA patients achieved significantly lesspainful joints (2.7 vs. 6.7, p=0.006), lower mean C-reactive protein (0.5mg/dLvs. 1.3mg/dL; P=0.011), and PhGA (18.3 vs. 28.1; P=0.020) at 3 months. In thelong term, early PsA patients also had fewer swollen joints (0.3 vs. 1.7;P=0.030) and lower PhGA (6.3 vs. 21.9; P<0.001), C-reactive protein(0.4mg/dL vs. 1.0mg/dL; P=0.026), and DAS28 (2.2 vs. 3.2; P=0.030). HAQ-DIdecreased in both groups reaching a mean value at 24 months of 0.4 and 0.8(P=ns)in early and late PsA, respectively. Early PsA patients obtained PsARC responsemore rapidly than late PsA (3.8 and 7.4 months, respectively; P=0.008). Concominant csDMARDs showed clinical benefit (2-year PsARC response, 88.3% vs.60.0%; P=0.044). Concomitant glucocorticoids had no effect on PsARC responseover 2 years of follow-up. Persistence on ADA was similar in both groups.

        Conclusion:Early PsA patients had a greater chance of improvement after ADAtherapy and better functional outcome, and achieved PsARC response more rapidlythan late PsA. In this cohort, comedication with csDMARDs was beneficial over 2 years.

        引自：Santos H, Eusebio M, Borges J, et al. Effectiveness of early adalimumab therapy in psoriatic arthritis patients from Reuma.pt-EARLY PsA. Acta Reumatol Port. 2017, 42: 287-299.