Age at onset determines severity and choice of treatment in early rheumatoid arthritis: a prospective study
Age at onset determines severity and choice of treatment in early rheumatoid arthritis: a prospective study
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DOI：
10.1186/ar4540
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发表时间：
2014-01-01
影响因子：
4.9
通讯作者：
Wallberg-Jonsson, Solveig
中科院分区：
文献类型：
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作者：
Innala, Lena;Berglin, Ewa;Wallberg-Jonsson, Solveig
前言：类风湿性关节炎(RA)患者的疾病活动性、严重程度和合并症增加了死亡率。我们评估了发病年龄对早期疾病患者预后危险因素和治疗的影响。方法：在这项研究中，950例RA患者从发病12个月起定期跟踪疾病活动(血沉(ESR)、C反应蛋白(CRP)、关节压痛和/或肿胀、视觉模拟评分疼痛和总体评分、28个关节疾病活动评分(DAS28)和功能(健康评估问卷(HAQ))。在纳入时和5年时，根据手和脚的X线片(基于Larsen评分的侵蚀)、关节外疾病、结节和合并症以及治疗(修改疾病的抗风湿药物(DMARDS)、皮质类固醇、生物制剂和非类固醇抗炎药物)来测量疾病严重程度。在纳入时分析自身抗体(类风湿因子、抗核抗体和抗环瓜氨酸肽(ACPAs)抗体)和遗传标记(人类白细胞抗体(HLA)共有表位和蛋白酪氨酸磷酸酶非受体22型(PTPN22))。结果：LORA与ACPA频率较低(P<；0.05)和携带PTPN22-T变异体(P<；0.01)有关，但在纳入时疾病活动性较强(P<；0.001)，C反应蛋白(P<；6个月(P<；0.01)、12个月(P<；0.01)和24个月(P<；0.05)的累积疾病活动度，以及更高的HAQ评分(P<；0.01)。在基线和24个月时，LORA更多地与糜烂(P<；0.01)和更高的Larsen评分(P<；0.001)有关。洛拉更多地使用皮质类固醇(P<；0.001)，较少使用甲氨蝶呤(P<；0.001)和生物制剂(P<；0.001)。约拉更多地与早期DMARD治疗有关(P<；0.001)。多元回归分析结果支持我们关于年龄对选择治疗的影响的研究结果。结论：YORA患者比LORA患者ACPA阳性率更高。LORA更多地与侵蚀、更高的Larsen评分、更高的疾病活动度和基线时更高的HAQ评分相关。然而，York a较早地接受了DMARDS的治疗，而Lora在早期疾病中更多地使用皮质类固醇治疗，而较少使用DMARDS。这些发现可能会对共病的发展产生影响。
Introduction: Disease activity, severity and comorbidity contribute to increased mortality in patients with rheumatoid arthritis (RA). We evaluated the impact of age at disease onset on prognostic risk factors and treatment in patients with early disease.Methods: In this study, 950 RA patients were followed regularly from the time of inclusion (< 12 months from symptom onset) for disease activity (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tender and/or swollen joints, Visual Analogue Scale pain and global scores, and Disease Activity Score in 28 joints (DAS28)) and function (Health Assessment Questionnaire (HAQ)). Disease severity, measured on the basis of radiographs of the hands and feet (erosions based on Larsen score), extraarticular disease, nodules, and comorbidities and treatment (disease-modifying antirheumatic drugs (DMARDs), corticosteroids, biologics and nonsteroidal anti-inflammatory drugs) were recorded at the time of inclusion and at 5 years. Autoantibodies (rheumatoid factor, antinuclear antibodies and antibodies against cyclic citrullinated peptides (ACPAs)) and genetic markers (human leucocyte antibody (HLA) shared epitope and protein tyrosine phosphatase nonreceptor type 22 (PTPN22)) were analysed at the time of inclusion. Data were stratified as young-onset RA (YORA) and late-onset RA (LORA), which were defined as being below or above the median age at the time of onset of RA (58 years).Results: LORA was associated with lower frequency of ACPA (P < 0.05) and carriage of PTPN22-T variant (P < 0.01), but with greater disease activity at the time of inclusion measured on the basis of ESR (P < 0.001), CRP (P < 0.01) and accumulated disease activity (area under the curve for DAS28 score) at 6 months (P < 0.01), 12 months (P < 0.01) and 24 months (P < 0.05), as well as a higher HAQ score (P < 0.01) compared with YORA patients. At baseline and 24 months, LORA was more often associated with erosions (P < 0.01 for both) and higher Larsen scores (P < 0.001 for both). LORA was more often treated with corticosteroids (P < 0.01) and less often with methotrexate (P < 0.001) and biologics (P < 0.001). YORA was more often associated with early DMARD treatment (P < 0.001). The results of multiple regression analyses supported our findings regarding the impact of age on chosen treatment.Conclusion: YORA patients were more frequently ACPA-positive than LORA patients. LORA was more often associated with erosions, higher Larsen scores, higher disease activity and higher HAQ scores at baseline. Nevertheless, YORA was treated earlier with DMARDs, whilst LORA was more often treated with corticosteroids and less often with DMARDs in early-stage disease. These findings could have implications for the development of comorbidities.