Analysis Of Prognostic Factors Of CDMARDs In The Treatment Of Rheumatoid Arthritis

Objective: Rheumatoid Arthritis(RA)is a chronic,systemic autoimmune disease that occurs in synovial joints and other tissues.Its pathogenesis is complex,which is related to the combination of heredity,environment,bacterial virus and many cytokines.It is one of the causes of high disability rate in China.The expectation of life of RA patients is nearly 10 years shorter than that of general population.This study explores the influencing factors and related laws of the prognosis of rheumatoid arthritis,so as to select different treatment schemes for patients with different clinical manifestations,and provide reference for the selection of clinical treatment schemes and the improvement of the treatment effect of RA patients.Methods: From January 2017 to December 2019,RA patients from the department of Rheumatology of the first affiliated hospital of China medical university,Shengjing Hospital of China Medical University and the First Affiliated Hospital of Jinzhou Medical University over the age of 18 years were collected.Recorded their basic information and drug use,screened and sorted out their drug use the patients were divided into groups to evaluate the index of joint swelling and pain,and the clinical biochemical indexes of patients were retrieved from the medical record data management platform.The DAS28 index before treatment was calculated,and the patients were followed up six months later.The therapeutic effect related index information of patients for six months was recorded,and the DAS28 index after treatment was calculated.The therapeutic effect of RA patients was evaluated by comparing ?DAS28 to determine whether there was curative effect or not.The database was established by Excel 2019 software.Statistical analyses were performed by IBM SPSS Statistics 22.0.(Statistical Product and Service Solutions,USA).In the statistical description,for descriptive analysis,the enumeration data is expressed as a percentage n(%).Mean ± standard deviation was used to represent the measurement data conforming to the normal distribution.and the non-normal data are expressed in median and interquartile spacing.For statistical analysis,measurement data in the univariate analysis were statistically analyzed by Student's t test or rank sum test.Count data were analyzed by chi-square tests.In addition,binary Logistic regression was used to analyze the factors related to the prognosis of RA patients,and a prediction model of RA prognosis was established.The ability to distinguish between the models was evaluated by ROC,the ability to correct was evaluated by Hosmer-lemeshow goodness of fit test,and the collinearity among the factors included in Logistic regression was comprehensively judged by tolerance and variance expansion factor,Filter the attributes that exist to verify collinearity.The statistical test was bilateral probability test,with P?0.05 as the statistical significance standard.Results: 521 patients were included in this study,including 97 males and 424 females.After six months of follow-up,196 patients had decreased disease activity,which was defined as effective,accounting for 37.6%;325 patients had not decreased disease activity,which was defined as ineffective,accounting for 67.4%.Descriptive analysis and univariate analysis were carried out after assigning values to the two groups of data.The results showed that the therapeutic effect of female patients was significantly higher than that of male patients(?2=3.892,P = 0.049).In the comparison of serum immunological index and biochemical indexes,CRP>5mg/L(?2= 5.7,P = 0.017),ESR>20mm/h(?2= 9.498),P=0.002)was significantly related to the therapeutic effect of RA.In the blood routine indexes,PDW increased(?2= 8.269,P=0.016)and HGB decreased(?2= 8.242,P=0.016)were significantly related to the therapeutic effect of RA.The results of single factor analysis showed that RF(P = 0.010),CRP(P=0.043),ESR(P = 0.042)were the influencing factors for the prognosis of male RA patients.Smoking(P = 0.037),CRP(P=0.034)and ESR(P<0.001)were the factors influencing the prognosis of female RA patients.The results showed that NLR(P = 0.016),LDL-C(P = 0.012),TG(P = 0.004),CRP(P=0.043),ESR(P = 0.004),PDW(P = 0.041),RBC(P = 0.032),HGB(P = 0.027),among which ESR and PDW were the protective factors,RBC and HGB were the risk factors,The prognostic factors of patients in the combined treatment group of methotrexate + leflunomide included Immunoglobulin(Ig M)(P=0.041)and HGB(P=0.016),among which Ig M increased as a protective factor and HGB increased as a risk factor.The prognosis models of RA patients were established and compared with those of drug classification.Finally,PDW,HGB and ESR were the influencing factors in the prognosis models of RA patients,LDL-C and CRP in methotrexate group,ESR,PDW and HGB in leflunomide group The results of verification and evaluation are as follows:the area under ROC curve of overall RA patients is 0.612,that under ROC curve of methotrexate treatment group is 0.737,and that under ROC curve of leflunomide treatment group is 0.627.Conclusion: 1.After 6-month treatment,the effective rate of female RA patients in Liaoning was higher than that of male patients.We should pay more attention to the prognosis risk factors of male patients and improve the prognosis of male patients.2.The prognosis of RA patients receiving non biological drug treatment is higher than that of male patients with higher levels of blood PDW and ESR before treatment.The prognosis of patients with HGB was worse.