A study of baseline prevalence and cumulative incidence of comorbidity and extra-articular manifestations in RA and their impact on outcome
A study of baseline prevalence and cumulative incidence of comorbidity and extra-articular manifestations in RA and their impact on outcome
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DOI：
10.1093/rheumatology/kes262
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发表时间：
2013-01-01
期刊：
影响因子：
5.5
通讯作者：
Young, Adam
中科院分区：
文献类型：
--
作者：
Norton, Sam;Koduri, Gouri;Young, Adam
目标.研究类风湿关节炎诊断时合并症的患病率和累积发生率，与临床特征的相关性以及对预后的影响。在英国9个地区的1460例最近诊断为RA的患者中，在基线和每年的初始队列中记录了RA的标准临床、实验室和放射学指标，以及合并症和关节外特征的详细信息。使用全科医学研究数据库比较常见共病的发生率（国际疾病分类-10个代码）。所有合并症和关节外特征的基线患病率分别为31.6%和8.6%，15年累积发病率分别为81%和53%。高血压[标准化发病率比（SIR）= 1.61; 95% CI 1.43，1.79]和缺血性心脏病的发生率（SIR = 1.60; 95% CI 1.35，1.84）与一般人群相比，女性卒中发生率升高（SIR = 1.34; 95% CI 1.02，1.77）和男性慢性阻塞性肺疾病（SIR = 1.63; 95% CI 1.17，2.26）。合并症与全因和心血管死亡风险（风险比= 1.09; 95% CI 1.02，1.17）和10年内功能下降率增加相关（B = 0.011; 95% CI 0.004，0.019）。合并症与疾病活动性及结构性损害无关。在RA开始时存在显著的合并症，随着随访而增加，主要是心血管、非心血管和呼吸系统。特定疾病（如高血压）的发生频率高于一般人群。合并症与死亡率和功能下降有关，这些患者可能需要考虑更强化的治疗。由于许多共存的条件是服从于预防/治疗措施，合并症需要早期检测和管理，以减少其对RA的结果的影响。
Objectives. To study the prevalence at diagnosis and cumulative incidence of comorbidity in RA, associations with clinical features and impact on outcome.Methods. Standard clinical, laboratory and radiological measures of RA, and details of comorbidity and extra-articular features were recorded at baseline and yearly in an inception cohort of 1460 patients with recently diagnosed RA from nine regions in the UK. The General Practice Research Database was used to compare the incidence of common comorbid conditions (International Classification for Disease-10 codes).Results. Baseline prevalence was 31.6% and 8.6% for all comorbidities and extra-articular features, respectively, and 15-year cumulative incidence was 81% and 53%, respectively. Rates of hypertension [standardized incidence ratio (SIR) = 1.61; 95% CI 1.43, 1.79] and ischaemic heart disease (SIR = 1.60; 95% CI 1.35, 1.84) were raised compared with figures for the general population, as was stroke in females (SIR = 1.34; 95% CI 1.02, 1.77) and chronic obstructive pulmonary disorder in males (SIR = 1.63; 95% CI 1.17, 2.26). Comorbidity was associated with risk of both all-cause and cardiovascular mortality (hazard ratio = 1.09; 95% CI 1.02, 1.17) and increased rates of functional decline over 10 years (b = 0.011; 95% CI 0.004, 0.019). Comorbidity was not related to disease activity or structural damage.Conclusion. Significant comorbidity was present at the outset of RA, increasing with follow-up, mainly in cardiovascular, non-cardiac vascular and respiratory systems. Specific conditions (e.g. hypertension) occurred more frequently than in the general population. Comorbidity was related to mortality and functional decline, and more intensive therapies may need consideration in these patients. As many co-existent conditions are amenable to preventative/therapeutic measures, comorbidity needs earlier detection and management in order to reduce its impact on outcome in RA.