Predictores de remisión clínica en pacientes con artritis reumatoide temprana : revisión sistemática

Abstract

Background/purpose: Clinical remission is the target in patients with rheumatoid arthritis (RA). Early diagnosis, optimal treatment, and recognize of baseline characteristics represents a crucial step for controlling the progression of the disease and the best opportunity to achieve full disease remission and prevention of joint injury and disability as well. The aim of this systematic review was to recognize and analyze predictors of remission that allow efficient stratification strategies and treatment options for patients with early RA fulfilling the 2010 ACR/EULAR classification criteria. Methods: A systematic literature review was conducted following the PRISMA guidelines. The search was performed in PubMed, Scopus, Embase, Cochrane, Science Citation Index (Web of Science) databases (up to November 2017) for prognostic studies in adults with early RA. The studies’ quality was examined using Quality in Prognosis Studies (QUIPS) tool. Results: A total of nineteen studies which had a total of 11.633 participants. All citations, fulfilled the inclusion criteria and were included in this study. The mayor outcome was clinical remission, defined using the disease activity score in 28 joints (DAS28 ≤ 2.6). The following variables were found to be the independent predictors of early RA remission: demographics: male sex, young age, abstaining from alcohol; genetics markers: high baseline miR-125b expression; Baseline clinical assessment: BMI <25; baseline remission; longer time to first remission; < 5 TJC-28; VERA; Laboratory measurements and radiography assessment: ESR, RF, ACPA, and ANA negativity 25-HydroxyvitaminD ≤ 20 mg/ml; Sharp–van der Heijde method; functional status: baseline MH; lower HAQ at baseline, PGA at 3 months response to treatments: early use of subcutaneous methotrexate, less use of steroids, initial treatment with triple therapy with DMARDs; DMARDs in combination within the 3rd month, fewer increases in medication after the initial visit and FIN-RACo regimen. Conclusion: This study summarized a number of independent predictors of remission in early RA and classify them into six groups. Moreover, this review has significant implications for clinical care and provides a better way to identify and address a risk stratification system, in order to optimize individual treatment strategy options and assure a long good quality of life. Due to many of these factors being modifiable an individual approach must be taken to alleviate and reduce disease progression. However, this study also highlights the need for further research, this patients should be taken into account in future randomized controlled trials.