Features and Outcomes of Elderly Rheumatoid Arthritis: Does the Age of Onset Matter? A Comparative Study From a Single Center in China.
Features and Outcomes of Elderly Rheumatoid Arthritis: Does the Age of Onset Matter? A Comparative Study From a Single Center in China.
复制标题
老年类风湿关节炎的特征和结果：发病年龄重要吗？
DOI：
10.1007/s40744-020-00267-8
复制
发表时间：
2021-03
影响因子：
3.8
通讯作者：
Lin J
中科院分区：
文献类型：
--
作者：
Ke Y;Dai X;Xu D;Liang J;Yu Y;Cao H;Chen W;Lin J
本研究的目的是研究老年类风湿关节炎的临床和影像学特征，并比较老年和年轻发病类风湿关节炎两个亚组（分别为EORA和YORA）的预后。我们对我院老年类风湿关节炎患者进行回顾性病例对照研究。EORA定义为发病年龄在60岁以上的患者。共收治142例老年类风湿关节炎患者，其中EORA组79例，YORA组63例。炎症参数包括c反应蛋白、d -二聚体、血清铁蛋白和血小板计数水平，EORA组均高于YORA组。EORA患者在健康评估问卷的残疾指数（p = 0.01）和患者整体健康评估（p = 0.049）得分较高，但在改良总锐评分（p = 0.001）得分较低。双因素logistic回归分析显示，老年发病（OR 2.30, 95% CI[1.45-3.77]）、年龄（OR 2.04, 95% CI[1.22-3.41]）、疾病活动性高（OR 1.90, 95% CI[1.17-3.32]）和红细胞分布宽度（OR 1.81, 95% CI[1.03-3.19]）是致残的独立预后因素。年龄（OR 0.25, 95% CI[0.07-0.91]）、病程（OR 2.73, 95% CI[0.97-7.70]）和合并糖尿病（OR 118.10, 95% CI[3]）。[50-3985.57])是导致老年人群放射关节损伤的独立因素。EORA患者死亡发生率高于YORA患者，预后差。Cox回归分析显示，合并症高血压（HR 12.02, 95% CI[1.08-133.54]）、间质性肺病（HR 85.04, 95% CI[4.11-1759.19]）和压缩性骨折（HR 85.04, 95% CI[4.11-1759.19]）是EORA患者死亡率的独立预测因素，ILD （HR 50.21, 95% CI[5.56-335.33]）和肺动脉高压（HR 25.37, 95% CI[3.03-265.81]）是EORA患者疾病无缓解的独立预测因素。EORA患者的独特特征使EORA成为不同于“典型类风湿关节炎”的独特实体。与老年YORA相比，EORA患者出现全身性炎症状态升级，生活质量下降，预后更差。控制ILD和糖尿病等合并症可能有利于老年类风湿关节炎的治疗。进一步研究EORA的发病机制和治疗策略是迫切需要的。在线版本包含补充材料，可在10.1007/s40744-020-00267-8获得。
The aim of this work is to investigate the clinical and radiological characteristics of elderly rheumatoid arthritis and compare the outcomes between the two subgroups, elderly- and young-onset rheumatoid arthritis (EORA and YORA, respectively). We conducted a retrospective case-control study on the elderly rheumatoid arthritis patients in our medical center. EORA was defined as the patient whose onset age was above 60. A total of 142 elderly rheumatoid arthritis patients were admitted, with 79 patients in EORA and 63 in YORA group. Inflammatory parameters including C-reactive protein, D-dimer, serum ferritin, and platelet count levels were all higher in the EORA group than those in YORA. EORA patients showed a higher score of health assessment questionnaire's disability index (p = 0.01) and patient global health assessment (p = 0.049), but a lower status of modified total sharp score (p = 0.001). Bivariate logistic regression analysis revealed that elderly onset of the disease (OR 2.30, 95% CI [1.45–3.77]), age (OR 2.04, 95% CI [1.22–3.41]), high disease activity (OR 1.90, 95% CI [1.17–3.32]), and red blood cell distribution width (OR 1.81, 95% CI [1.03–3.19]) were independent prognostic factors of disability. Age (OR 0.25, 95% CI [0.07–0.91]), disease duration (OR 2.73, 95% CI [0.97–7.70]), and co-morbid diabetes mellitus (OR 118.10, 95% CI [3. 50–3985.57]) independently contributed to radiographic joint damage in the elderly population. EORA patients showed increased death incidents and worse prognosis than YORA. Cox regression analysis reveals that comorbid hypertension (HR 12.02, 95% CI [1.08–133.54]), interstitial lung disease (ILD) (HR 85.04, 95% CI [4.11–1759.19]), and compressive fracture (HR 85.04, 95% CI [4.11–1759.19]) are independent predictors of mortality, and that ILD (HR 50.21, 95% CI [5.56–335.33]) and pulmonary hypertension (HR 25.37, 95% CI [3.03–265.81]) are independent predictors of no disease remission in the EORA patients. The distinct features of EORA patients make EORA a unique entity different from “classic rheumatoid arthritis”. EORA patients develop an upgraded systemic inflammatory status, more declined life quality, and worse prognosis than the elderly YORA. Better control of the comorbidities like ILD and diabetes mellitus may benefit the management of elderly rheumatoid arthritis. Further investigation regarding the pathogenesis and therapeutic strategies of EORA is urgently warranted. The online version contains supplementary material available at 10.1007/s40744-020-00267-8.
登录
查看更多内容
影响因子：
4.2
作者：
Krams, Thomas;Ruyssen-Witrand, Adeline;Constantin, Arnaud
通讯作者：
Constantin, Arnaud
影响因子：
27.4
作者：
Olofsson, T.;Petersson, I. F.;Neovius, M.
通讯作者：
Neovius, M.
影响因子：
2.5
作者：
Tan, Teck C.;Gao, Xiao;Koh, Ee-Tzun
通讯作者：
Koh, Ee-Tzun
DOI：
10.2174/1874325001610010793
发表时间：
2016
期刊：
The open orthopaedics journal
影响因子：
--
作者：
Mine T;Ihara K;Kawamura H;Kuriyama R;Date R
通讯作者：
Date R
影响因子：
--
作者：
DEAL, CL;MEENAN, RF;COHEN, AS
通讯作者：
COHEN, AS