Baseline Laboratory Test Abnormalities are Common in Early Arthritis but Rarely Contraindicate Methotrexate: Study of Three Cohorts (ESPOIR, VErA, and Brittany)

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• 作者：Marion Le Boë ; dec ; MD^? ; Thierry Marhadour ; MD^? ; Valé ; rie Devauchelle-Pensec ; MD ; PhD^? ; Sandrine Jousse-Joulin ; MD^? ; Aymeric Binard ; MD^? ; Bruno Fautrel ; MD ; PhD^&dagger ; ; René ; Marc Flipo ; MD^&Dagger ; ; Xavier Le Loë ; t ; MD^§ ; ; Jean Franç ; ois Mé ; nard ; MD^¡¬ ; Alain Saraux ; MD ; PhD^? ; ^{alain.saraux@chu-brest.fr}
• 关键词：Recent-onset arthritis ; Rheumatoid arthritis ; Anemia ; Cytolysis ; Methotrexate ; Renal failure
• 刊名：Seminars in Arthritis and Rheumatism
• 出版年：2013
• 出版时间：April, 2013
• 年：2013
• 卷：42
• 期：5
• 页码：474-481
• 全文大小：133 K

文摘

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Objective

To evaluate the prevalence of baseline abnormalities in standard laboratory tests in patients with early arthritis and their impact on selection of disease-modifying antirheumatic drugs according to American College of Rheumatology (ACR) recommendations and/or of nonsteroidal anti-inflammatory drugs.

Methods

In three cohorts of patients with early arthritis (the ESPOIR, VErA, and Brittany cohorts), we evaluated the prevalence of anemia (hemoglobin <1 3 g/dL in men and 12 g/dL in women), leukopenia (<3500 per mm³), thrombocytopenia (<150 000 per mm³), renal dysfunction (mild, creatinine clearance [CrCl]=60-89.9 mL/min; moderate, CrCl=30-59.9 mL/min; or severe, CrCl<30 mL/min), liver cytolysis (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]>N or>2N), and systemic inflammation (erythrocyte sedimentation rate [ESR]>20 and C-reactive protein [CRP]>6).

Results

We evaluated 1393 patients (1018 women and 375 men). Anemia was present in 363/1366 (26.5 % ) patients, leukopenia in 18/1372 (1.3 % ), and thrombocytopenia in 13/1371 (0.9 % ). ESR elevation was seen in 50.4 % of patients and CRP elevation in 62.7 % . The level of AST was above normal in 4 % and of ALT in 10 % of patients. No patient had severe renal dysfunction, 5.6 % had moderate renal dysfunction, and 42.6 % had mild renal dysfunction. Among the 1094 patients who had undergone all the tests, only 18 (1.64 % , 95 % confidence interval, 1-2.64) had a formal contraindication to methotrexate therapy according to ACR recommendations (4 had leukopenia, 12 had high ALT levels, and 2 had high ALT and AST levels).

Conclusion

Patients with recent-onset arthritis often have anemia, mild or moderate renal dysfunction, and abnormal liver function. However, fewer than 2 % have laboratory test abnormalities contraindicating methotrexate therapy.