Improved survival in psoriatic arthritis with calendar time
Improved survival in psoriatic arthritis with calendar time
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DOI：
10.1002/art.22800
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发表时间：
2007-08-01
影响因子：
--
通讯作者：
Gladman, Dafna D.
中科院分区：
文献类型：
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作者：
Ali, Yaser;Tom, Brian D. M.;Gladman, Dafna D.
客观的。旨在确定过去 30 年来对银屑病关节炎 (PsA) 病例进行前瞻性随访的患者死亡率是否发生变化。方法。包括 1978 年至 2004 年间在多伦多大学 PsA 诊所按照标准方案接受后续护理的患者。前瞻性地收集有关患者死亡的信息。使用 1978 年至 2004 年加拿大安大略省一般人口的死亡率数据（按 5 岁年龄段、性别和日历年分层）来计算参考率。通过使用泊松回归模型计算观察到的死亡人数，计算标准化死亡率（SMR）。通过使用 10 年“滚动平均”SMR 和按进入临床时期分层的随访期特定 SMR 进行时间趋势分析。结果。在 680 名 PsA 患者中，106 名（15.6%）（55 名女性和 51 名男性）死亡。主要死因是循环系统疾病、肿瘤、呼吸系统疾病、胃肠系统疾病、受伤/中毒和不明原因。 1978-2004 年期间的总体 SMR 为 1.36（95% 置信区间为 1.12、1.64）。 PsA 患者队列总体损失的生命年估计为 2.99 年（95% 置信区间 1.14，4.77）。对于1978-1986年间进入队列的患者，1978-1986年、1987-1995年和1996-2004年随访期的SMR分别为1.89、1.83和1.21。对于19871995年进入队列的患者，SMR为0.55和0.82，而1996-2004年进入队列的患者SMR为0.56。结论。该 PsA 诊所人群的 SMR 下降表明死亡风险随着时间的推移有所改善。这种生存率的提高可能反映了早期队列中出现的疾病严重程度以及在最近的随访期间的早期诊断和更积极的治疗。
Objective. To determine whether there has been a change in mortality rates over the last 3 decades in patients with psoriatic arthritis (PsA) whose cases were followed prospectively.Methods. Patients receiving followup care according to a standard protocol at the University of Toronto PsA Clinic between 1978 and 2004 were included. Information on patient deaths was collected prospectively. Mortality data for the general population of Ontario, Canada, stratified by 5-year age bands, sex, and calendar year from 1978 to 2004, were used to calculate the reference rates. Standardized mortality ratios (SMRs) were calculated through use of Poisson regression models for the number of observed deaths. Time trend analyses were performed through the use of 10-year "rolling-average" SMRs and followup period-specific SMRs stratified by the period of entry into clinic.Results. Of 680 patients with PsA, 106 (15.6%) (55 women and 51 men) have died. Major causes of death were disease of the circulatory system, neoplasms, diseases of the respiratory system, diseases of the gastrointestinal system, injuries/poisoning, and unknown. The overall SMR for the period 1978-2004 was 1.36 (95% confidence interval 1.12, 1.64). The estimated number of life-years lost by the PsA patient cohort overall was 2.99 years (95% confidence interval 1.14, 4.77). For patients who entered the cohort during the years 1978-1986, the SMRs were 1.89, 1.83, and 1.21 for followup periods 1978-1986, 1987-1995, and 1996-2004, respectively. For patients who entered the cohort during the years 19871995, the SMRs were 0.55 and 0.82, while the SMR for those who entered during 1996-2004 was 0.56.Conclusion. The drop in SMRs in this PsA clinic population suggests that the mortality risk has improved over time. This improved survival may reflect disease severity at presentation in the earlier cohort as well as earlier diagnosis and more aggressive treatment in the more recent followup period.