Clin Rheumatol. 2018;37(2):307-314.
Pivotal factors for successful withdrawal of nonsteroidal anti-inflammatory drugs in rheumatoid arthritis patients in remission or with low-disease activity.
제1저자 고동진 · 교신저자 송영욱
소속 (11)
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, South Korea.
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Borame Medical Center, Seoul, South Korea.
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea.
- Division of Rheumatology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, South Korea.
- Division of Rheumatology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea.
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Disease, Seoul, South Korea.
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Korea, Seoul St Mary's Hospital, Seoul, South Korea.
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. ysong@snu.ac.kr.
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, South Korea. ysong@snu.ac.kr.
Abstract
The purpose of this study is to examine the patient-reported outcomes (PRO) after discontinuing nonsteroidal anti-inflammatory drugs (NSAIDs) and clinical factors associated with a favorable outcome in patients with rheumatoid arthritis (RA) in remission or with low-disease activity (LDA). A 16-week prospective open-label trial was conducted at eight rheumatology clinics in Korea. RA patients with 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) < 3.2 who were on NSAIDs for more than a month were enrolled, and NSAIDs were discontinued. Acetaminophen (AAP) was used as the rescue medication, and NSAIDs were restarted when joint pain was intolerable with AAP. The endpoint was to analyze the group of patients who continued to withdraw NSAIDs. Among 109 enrolled patients, 105 completed the 16-week follow-up. Eighty-nine (84.8%) patients remained without restarting NSAIDs. In these patients, there was a slight increase in their pain levels compared with baseline (median 14.0 versus 19.0 using the pain-visual analog scale, p = 0.010). However, changes in DAS28-ESR (p = 0.638) and routine assessment of patient index data 3 (RAPID-3) (p = 0.128) were insignificant. Moreover, 66 (62.9%) patients showed sustained effectiveness on PRO without restarting NSAIDs. In the multivariate regression models, joint swelling was the detrimental factor in NSAID withdrawal (odds ratio [OR] 0.149, 95% confidence interval [CI] 0.033-0.680, p = 0.014) and sustained effectiveness (OR 0.284, 95% CI 0.091-0.883, p = 0.030). Joint pain in RA patients in remission or with LDA can be well managed without NSAIDs, especially in those without swollen joints at the time of cessation.
Keywords
NSAIDsOutcome measuresPain controlRheumatoid arthritis
그 밖의 정보
- 출판 형태
- Journal Article
- 저널
- Clinical rheumatology · eISSN 1434-9949
- 전자 출판
- 2017-10-08
- MeSH
- Adult · Aged · Anti-Inflammatory Agents, Non-Steroidal / therapeutic use · Antirheumatic Agents / therapeutic use · Arthritis, Rheumatoid / diagnosis / drug therapy · Female · Humans · Male · Middle Aged · Pain Measurement · Remission Induction · Severity of Illness Index · Withholding Treatment
- Substances
- Anti-Inflammatory Agents, Non-Steroidal · Antirheumatic Agents
- 연구비
- Ministry of Health and Welfare HI10C2020 · Ministry of Health and Welfare HI14C1277
- 참고문헌
- 25편