Cause-specific mortality in patients with psoriatic arthritis and rheumatoid arthritis
Cause-specific mortality in patients with psoriatic arthritis and rheumatoid arthritis
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DOI：
10.1093/rheumatology/kew502
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发表时间：
2017-06-01
期刊：
影响因子：
5.5
通讯作者：
Gelfand, Joel M.
中科院分区：
文献类型：
--
作者：
Ogdie, Alexis;Maliha, Samantha;Gelfand, Joel M.
目标。本研究的目的是比较PsA患者与普通人群和ra患者的病因特异性死亡率。采用The Health Improvement Network对1994 - 2010年18-89岁的患者进行队列研究。PsA和RA由医学规范定义，并在实践和实践开始日期上匹配多达10名未暴露对照。死因根据英国死亡统计数据分类。每个死亡病例都经过人工审查，以确保适当的分类。采用竞争风险生存回归法计算年龄和性别校正风险比（HRs）和多变量校正风险比（HRs）。在PsA（8706）、RA（41 752）和未暴露对照组（81 573）患者中，分别观察到470、7004和5269例死亡。所有患者中最常见的死亡原因是心血管疾病，其次是恶性肿瘤、呼吸道死亡和感染。死因不明，25%左右。在PsA患者中，心血管（1.09,0.91-1.32）、呼吸（0.97,0.79-1.20）、恶性肿瘤（1.03,0.86-1.25）和感染死亡率（1.05,0.79-1.39）均未升高。RA患者中，心血管（1.55,1.44-1.66）、呼吸（1.85,1.72-2.01）、恶性肿瘤（1.18,1.08-1.28）和感染（2.21,2.00-2.44）的死亡率与对照组相比显著升高。虽然不太常见，但PsA和RA的自杀死亡率升高（HR分别为3.03和2.47）。除自杀死亡外，PsA患者的总死亡率和死因特异性死亡率风险均未升高。类风湿性关节炎患者死于心血管疾病、呼吸系统疾病、癌症和传染病的风险增加。
Objective. The objective of this study was to examine cause-specific mortality in patients with PsA compared with the general population and compared with patients with RA.Methods. A cohort study was performed using The Health Improvement Network among patients aged 18-89 years with data from 1994 to 2010. PsA and RA were defined by medical codes, and up to 10 unexposed controls were matched on practice and start date within the practice. Cause of death was classified using categories from UK death statistics. Each death was manually reviewed to ensure appropriate classification. Age-and sex-adjusted hazard ratios (HRs) and multivariable adjusted HRs were calculated using competing risks survival regression.Results. Among patients with PsA (8706), RA (41 752) and unexposed controls (81 573), 470, 7004 and 5269 deaths were observed, respectively. The most common causes of death among all patients were cardiovascular disease, followed by malignancy, respiratory deaths and infection. Cause of death was unknown in similar to 25%. Among PsA patients, cardiovascular (1.09, 0.91-1.32), respiratory (0.97, 0.79-1.20), malignancy (1.03, 0.86-1.25) and infection deaths (1.05, 0.79-1.39) were not elevated. Among patients with RA, cardiovascular (1.55, 1.44-1.66), respiratory (1.85, 1.72-2.01), malignancy (1.18, 1.08-1.28) and infection deaths (2.21, 2.00-2.44) were significantly elevated compared with population controls. Although less common, suicide deaths were elevated in PsA and RA (HR 3.03 and 2.47, respectively).Conclusion. Overall mortality and cause-specific mortality risk were not elevated among patients with PsA except for suicide deaths. Patients with RA were at increased risk of deaths from cardiovascular, respiratory, cancer and infectious diseases.