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*Only for medical professionals to read for reference.
Why is RA disease remission so important? Since the introduction of the definition of "disease relief" in the treatment concept of rheumatoid arthritis (RA), more and more patients have benefited from it clinically.
This definition also provides a broad prospect for the research and practice of RA treatment
.
Especially in the era of targeted therapy of biological agents, the disease remission of RA is becoming more and more strict.
Although the connotation and extension of the definition still need to be unified, disease remission is of great significance to the improvement of symptoms and long-term benefits of RA patients
.
The 2021 American Academy of Rheumatology Annual Meeting (ACR 2021) also shared some sharing on the remission of RA disease.
In this regard, Director Mikrayi of the People's Hospital of Xinjiang Uygur Autonomous Region and everyone updated their understanding of the remission of RA disease
.
Why the treatment goal of RA emphasizes disease remission In the clinical practice and research of RA, many factors affect the treatment goal, especially "disease remission"
.
For the treatment of RA, improving the quality of life of patients is the main goal of treatment, which means that RA disease management not only pays attention to the reduction of clinical symptoms, but also pays attention to the overall treatment response and prognosis of the patient
.
In recent years, the academic community has increasingly advocated a "patient-centered" treatment model, and both doctors and patients' pursuit and expectations for disease activity need to be paid attention to
.
In this context, the treatment goal of disease remission can best meet the actual treatment outcome, and can also reduce the number of hospitalizations of patients, offset the impact of the disease on the work and life of patients to a greater extent, and reduce the medical expenses of patients
.
What are the effects of RA disease remission? Effects on the cardiovascular system.
In a clinical trial involving 24989 subjects, the investigator’s median follow-up time for the subjects was 2.
7 years.
It was found that the degree of disease remission was related to the reduced risk of cardiovascular disease.
The specific manifestations were clinical The disease activity index (CDAI) is reduced by 10 points for every 10 points, and the cardiovascular risk is reduced by 21%
.
And, under the intervention of the study (Figure 1), 53% of subjects' disease activity decreased from high activity to disease remission
.
Figure 1: Model A is only adjusted for age and gender
.
Model B was adjusted for age, gender, age interaction, and cardiovascular risk factors (previous myocardial infarction, coronary heart disease, diabetes, hypertension, hyperlipidemia, smoking, body mass index, family history of myocardial infarction, and aspirin use)
.
Model C targets all variables in Model B plus RA disease duration and non-steroidal anti-inflammatory drugs or selective cyclooxygenase-2 (COX-2) inhibitors, corticosteroids, disease-improving anti-rheumatic drugs and biological drugs The baseline usage is corrected
.
Studies on the impact on the incidence of severe infections in RA patients have shown that reduced RA disease activity may reduce the risk of severe infections (Figure 2)
.
Figure 2: Cl, confidence interval; IRR, incidence rate; LDA, low disease activity; MHDA, moderate to high disease activity; remission: CDAI≤2.
8; LDA:2.
8<CDAI<10; MHDA:CDAI>10
.
a.
Sustained remission/LDA/MHDA: The patient did not reach remission/LDA/MHDA before the patient got remission/LDA/MHDA for two consecutive visits; b.
Severe infection: Infection event that requires hospitalization or intravenous antibiotic treatment
.
The impact of orthopedic events in early RA patients After follow-up of 2045 early RA patients, the researchers found that if the disease activity of RA patients continues to be at a medium or high level, it may lead to a decrease in the patient's body function and cause long-term orthopedic events ( Fractures, orthopedic surgery, etc.
), and the cumulative incidence of orthopedic surgery in early RA patients increased with the increase in the score of RA patients' condition evaluation (DAS28) (Figure 3)
.
Figure 3: Relief (DAS28 ≤2.
6), low (2.
6-3.
2), medium/low (3.
2-4.
19), medium/high (4.
2-5.
1) and high (DAS28>5.
1)
.
Research on the impact of anxiety/depression status in RA patients has shown that compared with patients who have not achieved DAS28 disease remission, RA patients who have achieved remission are less likely to show symptoms related to anxiety and depression (Figure 4)
.
Figure 4: The impact of disease activity on the mental state of RA patients and the impact on the quality of life of patients The study shows that the quality of life scores of patients who achieve disease remission are relatively higher (Figure 5)
.
Figure 5: The impact of disease activity on the quality of life on the work and life of patients The study shows that patients who achieve the simplified disease activity index (SDAI) disease remission have better body function and work ability (Figure 6), and achieve Patients relieved by CDAI have less impaired mobility and greater work ability (Figure 7)
.
Figure 6: The effect of disease activity on body function and work ability Figure 7: The effect of working ability and the relationship between body damage and disease activity on the duration of symptoms.
The study found that the reduction in the duration of morning stiffness is also related to disease activity Decrease related (Figure 8)
.
Figure 8: Summary of the association between the duration of morning stiffness and disease activity.
Many studies have shown that achieving disease remission can reduce cardiovascular risk, socioeconomic burden, infectious disease risk, and the risk of anxiety and depression, while increased disease activity may be Increase the risk of lymphoma and orthopedic surgery
.
Therefore, in the management of RA disease, disease remission is very important
.
Although the current standards for RA disease remission have not yet been unified, different approaches have reached the same goal, and improvement of the quality of life of patients should still be the core goal of clinical treatment
.
Expert profile Mikrayi Deputy Chief Physician of the Department of Rheumatology and Immunology, People's Hospital of Xinjiang Uygur Autonomous Region
.
Young member of the Chinese Medical Association Rheumatology Branch, Youth Member of the Chinese Medical Association Microbiology and Immunity Branch, Member of the Osteoporosis Group of the Chinese Medical Doctor Association Rheumatology Branch, Member of the Vasculitis Group of the Rheumatology Branch of the Cross-Strait Medical and Health Exchange Association, Xinjiang Doctor The young member of the Society of Rheumatology and Immunology, and the member of the Xinjiang Medical Association of Traditional Chinese and Western Medicine and Rheumatology
.
Why is RA disease remission so important? Since the introduction of the definition of "disease relief" in the treatment concept of rheumatoid arthritis (RA), more and more patients have benefited from it clinically.
This definition also provides a broad prospect for the research and practice of RA treatment
.
Especially in the era of targeted therapy of biological agents, the disease remission of RA is becoming more and more strict.
Although the connotation and extension of the definition still need to be unified, disease remission is of great significance to the improvement of symptoms and long-term benefits of RA patients
.
The 2021 American Academy of Rheumatology Annual Meeting (ACR 2021) also shared some sharing on the remission of RA disease.
In this regard, Director Mikrayi of the People's Hospital of Xinjiang Uygur Autonomous Region and everyone updated their understanding of the remission of RA disease
.
Why the treatment goal of RA emphasizes disease remission In the clinical practice and research of RA, many factors affect the treatment goal, especially "disease remission"
.
For the treatment of RA, improving the quality of life of patients is the main goal of treatment, which means that RA disease management not only pays attention to the reduction of clinical symptoms, but also pays attention to the overall treatment response and prognosis of the patient
.
In recent years, the academic community has increasingly advocated a "patient-centered" treatment model, and both doctors and patients' pursuit and expectations for disease activity need to be paid attention to
.
In this context, the treatment goal of disease remission can best meet the actual treatment outcome, and can also reduce the number of hospitalizations of patients, offset the impact of the disease on the work and life of patients to a greater extent, and reduce the medical expenses of patients
.
What are the effects of RA disease remission? Effects on the cardiovascular system.
In a clinical trial involving 24989 subjects, the investigator’s median follow-up time for the subjects was 2.
7 years.
It was found that the degree of disease remission was related to the reduced risk of cardiovascular disease.
The specific manifestations were clinical The disease activity index (CDAI) is reduced by 10 points for every 10 points, and the cardiovascular risk is reduced by 21%
.
And, under the intervention of the study (Figure 1), 53% of subjects' disease activity decreased from high activity to disease remission
.
Figure 1: Model A is only adjusted for age and gender
.
Model B was adjusted for age, gender, age interaction, and cardiovascular risk factors (previous myocardial infarction, coronary heart disease, diabetes, hypertension, hyperlipidemia, smoking, body mass index, family history of myocardial infarction, and aspirin use)
.
Model C targets all variables in Model B plus RA disease duration and non-steroidal anti-inflammatory drugs or selective cyclooxygenase-2 (COX-2) inhibitors, corticosteroids, disease-improving anti-rheumatic drugs and biological drugs The baseline usage is corrected
.
Studies on the impact on the incidence of severe infections in RA patients have shown that reduced RA disease activity may reduce the risk of severe infections (Figure 2)
.
Figure 2: Cl, confidence interval; IRR, incidence rate; LDA, low disease activity; MHDA, moderate to high disease activity; remission: CDAI≤2.
8; LDA:2.
8<CDAI<10; MHDA:CDAI>10
.
a.
Sustained remission/LDA/MHDA: The patient did not reach remission/LDA/MHDA before the patient got remission/LDA/MHDA for two consecutive visits; b.
Severe infection: Infection event that requires hospitalization or intravenous antibiotic treatment
.
The impact of orthopedic events in early RA patients After follow-up of 2045 early RA patients, the researchers found that if the disease activity of RA patients continues to be at a medium or high level, it may lead to a decrease in the patient's body function and cause long-term orthopedic events ( Fractures, orthopedic surgery, etc.
), and the cumulative incidence of orthopedic surgery in early RA patients increased with the increase in the score of RA patients' condition evaluation (DAS28) (Figure 3)
.
Figure 3: Relief (DAS28 ≤2.
6), low (2.
6-3.
2), medium/low (3.
2-4.
19), medium/high (4.
2-5.
1) and high (DAS28>5.
1)
.
Research on the impact of anxiety/depression status in RA patients has shown that compared with patients who have not achieved DAS28 disease remission, RA patients who have achieved remission are less likely to show symptoms related to anxiety and depression (Figure 4)
.
Figure 4: The impact of disease activity on the mental state of RA patients and the impact on the quality of life of patients The study shows that the quality of life scores of patients who achieve disease remission are relatively higher (Figure 5)
.
Figure 5: The impact of disease activity on the quality of life on the work and life of patients The study shows that patients who achieve the simplified disease activity index (SDAI) disease remission have better body function and work ability (Figure 6), and achieve Patients relieved by CDAI have less impaired mobility and greater work ability (Figure 7)
.
Figure 6: The effect of disease activity on body function and work ability Figure 7: The effect of working ability and the relationship between body damage and disease activity on the duration of symptoms.
The study found that the reduction in the duration of morning stiffness is also related to disease activity Decrease related (Figure 8)
.
Figure 8: Summary of the association between the duration of morning stiffness and disease activity.
Many studies have shown that achieving disease remission can reduce cardiovascular risk, socioeconomic burden, infectious disease risk, and the risk of anxiety and depression, while increased disease activity may be Increase the risk of lymphoma and orthopedic surgery
.
Therefore, in the management of RA disease, disease remission is very important
.
Although the current standards for RA disease remission have not yet been unified, different approaches have reached the same goal, and improvement of the quality of life of patients should still be the core goal of clinical treatment
.
Expert profile Mikrayi Deputy Chief Physician of the Department of Rheumatology and Immunology, People's Hospital of Xinjiang Uygur Autonomous Region
.
Young member of the Chinese Medical Association Rheumatology Branch, Youth Member of the Chinese Medical Association Microbiology and Immunity Branch, Member of the Osteoporosis Group of the Chinese Medical Doctor Association Rheumatology Branch, Member of the Vasculitis Group of the Rheumatology Branch of the Cross-Strait Medical and Health Exchange Association, Xinjiang Doctor The young member of the Society of Rheumatology and Immunology, and the member of the Xinjiang Medical Association of Traditional Chinese and Western Medicine and Rheumatology
.
