Background Major improvements in the management of rheumatoid arthritis (RA) have made clinical remission an achievable and desirable goal but, despite the relevance gained by a profound disease suppression, many patients with RA still miss clinical remission due to several factors influencing disease activity, including treatment adherence. Objective To evaluate the effect of adherence to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) on the achievement of clinical remission in a cohort of patients with new-onset inflammatory arthritis. Study design A prospective cohort study was conducted using the ELECTRA database, which consists of clinical data from patients followed at the IRCCS Policlinico San Matteo Foundation (Pavia, Italy), linked to regional administrative healthcare databases. Methods We enrolled patients with new-onset active disease between January 2006 and December 2013 and followed them until their first clinical remission or end of follow-up (December 2015). To assess the association of csDMARD adherence with clinical remission, we estimated the csDMARD proportion of days covered (PDC) during follow-up. PDC was added to the main clinical adjustment covariates as a time-dependent variable in a proportional hazard Cox regression model. Results The cohort included 324 patients with a mean (SD) age of 58 (13.9) and predominantly female (74.5%). A total of 219 patients (67.6%) achieved clinical remission during follow-up and 85 (26.2%) in the first 6 months (early clinical remission). Cox regression models showed that a 10% increment of PDC increased the probability of achieving clinical remission by 10% (p < 0.001) and the probability of early clinical remission by 21% (p = 0.03). Conclusion Patients at disease onset with higher adherence to csDMARDs were more likely to achieve clinical remission and early clinical remission. Our study highlighted the importance of close monitoring of patients to increase their likelihood of following therapeutic indications and achieving favorable disease outcomes, such as lower disability.

中文翻译：

---

csDMARD 依从性对新发炎症性关节炎患者临床缓解的影响：来自 ELECTRA 数据库的一项前瞻性队列研究。

背景 类风湿性关节炎 (RA) 治疗的重大改进已使临床缓解成为可实现且理想的目标，但是，尽管通过深刻的疾病抑制获得了相关性，但由于影响疾病活动的多种因素，许多 RA 患者仍然错过临床缓解，包括治疗依从性。目的 评估坚持使用传统合成缓解病情抗风湿药 (csDMARD) 对新发炎症性关节炎患者临床缓解的影响。研究设计 使用 ELECTRA 数据库进行了一项前瞻性队列研究，该数据库包含来自 IRCCS Policlinico San Matteo 基金会（意大利帕维亚）跟踪的患者的临床数据，并与区域行政医疗保健数据库相连。方法 我们招募了 2006 年 1 月至 2013 年 12 月期间新发活动性疾病的患者，并对他们进行随访，直到他们的首次临床缓解或随访结束（2015 年 12 月）。为了评估 csDMARD 依从性与临床缓解的关联，我们估计了随访期间 csDMARD 覆盖天数 (PDC) 的比例。PDC 作为比例风险 Cox 回归模型中的时间相关变量添加到主要临床调整协变量中。结果 该队列包括 324 名患者，平均 (SD) 年龄为 58 (13.9) 岁，主要为女性 (74.5%)。共有 219 名患者（67.6%）在随访期间达到临床缓解，85 名患者（26.2%）在前 6 个月内达到临床缓解（早期临床缓解）。Cox 回归模型显示，PDC 每增加 10%，实现临床缓解的概率就会增加 10% (p < 0.001)，早期临床缓解的概率就会增加 21% (p = 0.03)。结论 发病时 csDMARD 依从性较高的患者更有可能实现临床缓解和早期临床缓解。我们的研究强调了密切监测患者的重要性，以增加他们遵循治疗适应症并实现良好疾病结果（例如降低残疾率）的可能性。