Hand-dominant joint involvement pattern associates with favourable, and polyarthritis with unfavourable, treatment response to both csDMARDs and bDMARDs in early rheumatoid arthritis: a combined analysis of NORD-STAR and BeSt trials.

Methods

An individual patient data meta-analysiswas conducted using 2 randomised controlled trials, NOrdic Rheumatic Diseases Strategy Trials And Registries (NORD-STAR) and Behandel-Strategieën (BeSt), including 1250 treatment-naïve patients with early RA.

利用2项随机对照试验，即北欧风湿病策略试验和登记处（NORD-STAR）以及治疗策略（BeSt），对1250名早期RA治疗未经验患者进行了个体患者数据的荟萃分析。

JIP subgroup assignment was based on 4 previously identified subgroups defined by baseline clinical characteristics, primarily joint involvement in the 66/68 joint scheme.

JIP亚组分配是基于先前确定的4个亚组，这些亚组是根据基线临床特征定义的，主要依据是66/68关节方案中的关节受累情况。

Treatment outcomes were measured using the longitudinal Clinical Disease Activity Index (CDAI) and other disease activity indices through week 48.

治疗结果是通过使用纵向临床疾病活动指数（CDAI）和其他疾病活动指数在第48周进行测量的。

Associations of the JIP subgroups and other clinical predictors were evaluated using a mixed-model analysis.

使用混合模型分析评估了JIP亚组与其他临床预测因素之间的关联。

Results

Patients with a hand-dominant JIP (JIP-Hand) showed significantly better CDAI scores after treatment (Beta for CDAI = -1.4 [95% CI, -2.3 to -0.55]; p = .0016), whereas those with a polyarthritis pattern (JIP-Poly) exhibited worse outcomes (Beta = 0.95 [95% CI, 0.064-1.8]; p = .035).

治疗后，以手部为主的JIP（JIP-Hand）患者显示出显著更好的CDAI评分（CDAI的Beta值为-1.4 [95% 置信区间, -2.3至-0.55]；p = .0016），而多关节炎模式（JIP-Poly）的患者表现出更差的结果（Beta = 0.95 [95% 置信区间, 0.064-1.8]；p = .035）。

Female sex was also associated with worse CDAI scores (Beta = 1.2 [95% CI, 0.40-2.0]; p = .0031), whereas anticitrullinated protein antibodies did not show a significant association (Beta = 0.19 [95% CI, -0.69 to 1.1]; p = .67).

女性性别也与较差的克罗恩病活动指数（CDAI）评分相关（Beta = 1.2 [95% 置信区间, 0.40-2.0]; p = .0031），而抗环瓜氨酸肽抗体（ACPA）未显示出显著相关性（Beta = 0.19 [95% 置信区间, -0.69至1.1]; p = .67）。

When compared across groups, csDMARDs and combined bDMARDs were similarly effective in the respective JIP subgroups (interaction p > .10).

在不同组间比较时，传统合成疾病修饰性抗风湿药物（csDMARDs）和联合生物制剂疾病修饰性抗风湿药物（bDMARDs）在各自的JAK抑制剂相关性贫血（JIP）亚组中效果相似（交互作用p > .10）。

Conclusions

In early RA, csDMARD and bDMARD treatments resulted in the greatest improvement in disease activity in JIP-Hand and the least improvement in JIP-Poly.

在早期类风湿关节炎中，csDMARD和bDMARD治疗在JIP-Hand中疾病活动度的改善最大，在JIP-Poly中改善最小。