Mortality following new-onset Rheumatoid Arthritis: has modern Rheumatology had an impact?
Mortality following new-onset Rheumatoid Arthritis: has modern Rheumatology had an impact?
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DOI：
10.1136/annrheumdis-2017-212131
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发表时间：
2018-01-01
影响因子：
27.4
通讯作者：
Askling, Johan
中科院分区：
文献类型：
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作者：
Holmqvist, Marie;Ljung, Lotta;Askling, Johan
目的探讨类风湿性关节炎（RA）的患者在最近几年中是否以及何时被诊断为死亡的风险增加。方法使用广泛的注册链接，我们设计了一个以人群为基础的全国性队列研究在瑞典。对来自瑞典风湿病质量登记处的新发RA患者和来自普通人群的单独匹配对照者进行死亡随访，如总人口登记处所捕获的。和78847例匹配的一般人群对照受试者，从RA诊断开始随访至死亡、移民或2015年12月31日。在RA队列和一般人群中，绝对死亡率随日历时间稳步下降。尽管RA队列中的相对死亡风险未增加（HR=1.01，95% CI 0.96 - 1.06），但在RA诊断的所有日历期间，RA队列中在RA诊断后5年存在超额死亡率（自RA诊断后10年的HR =1.43（95% CI 1.28 - 1.59））。考虑到RA疾病的持续时间，有没有明显的趋势，对较低的超额死亡率为患者诊断最近.Conclusions尽管死亡率下降，RA继续与死亡风险增加。因此，尽管近年来在RA管理方面取得了进展，但仍需要加大努力，从疾病发作开始预防疾病进展和合并症。
Objective To investigate if, and when, patients diagnosed with rheumatoid arthritis (RA) in recent years are at increased risk of death.Methods Using an extensive register linkage, we designed a population-based nationwide cohort study in Sweden. Patients with new-onset RA from the Swedish Rheumatology Quality Register, and individually matched comparators from the general population were followed with respect to death, as captured by the total population register.Results 17 512 patients with new-onset RA between 1 January 1997 and 31 December 2014, and 78 847 matched general population comparator subjects were followed from RA diagnosis until death, emigration or 31 December 2015. There was a steady decrease in absolute mortality rates over calendar time, both in the RA cohort and in the general population. Although the relative risk of death in the RA cohort was not increased (HR=1.01, 95% CI 0.96 to 1.06), an excess mortality in the RA cohort was present 5 years after RA diagnosis (HR after 10 years since RA diagnosis=1.43 (95% CI 1.28 to 1.59)), across all calendar periods of RA diagnosis. Taking RA disease duration into account, there was no clear trend towards lower excess mortality for patients diagnosed more recently.Conclusions Despite decreasing mortality rates, RA continues to be linked to an increased risk of death. Thus, despite advancements in RA management during recent years, increased efforts to prevent disease progression and comorbidity, from disease onset, are needed.