Overlapping Sjogren's syndrome reduces the probability of reaching target in rheumatoid arthritis patients: a propensity score matched real-world cohort from 2009 to 2019
Overlapping Sjogren's syndrome reduces the probability of reaching target in rheumatoid arthritis patients: a propensity score matched real-world cohort from 2009 to 2019
复制标题
重叠干燥综合征降低了类风湿关节炎患者达到目标的可能性：倾向评分与 2009 年至 2019 年真实世界队列相匹配
DOI：
10.1186/s13075-020-02189-w
复制
发表时间：
2020-05-01
影响因子：
4.9
通讯作者：
Zhang, Zhuoli
中科院分区：
文献类型：
--
作者：
Zhang, Huijuan;Zhang, Haoze;Zhang, Zhuoli
背景重叠干燥综合征（SS）在类风湿关节炎（RA）中并不少见，被认为是RA的一个可能的危险因素。但是关于重叠SS对RA治疗反应影响的数据有限。我们目前的研究旨在确定2009年至2019年真实世界队列的影响。方法回顾性分析2009 - 2019年在我院风湿病门诊就诊的RA患者的病历资料。在每个随访时间点收集他们的复合疾病活动评分。比较RA伴SS（RA-SS）和无SS（RA-noSS）患者的治疗反应。为了纠正可能影响治疗反应的混杂因素，使用考克斯比例风险模型分析了倾向评分匹配和不匹配队列。结果1099例RA患者中，129例（11.7%）与SS重叠，经抗SSA阳性或小涎腺活检证实为SS。在基于其基线特征的倾向评分匹配后，129例RA-SS患者中的126例和970例RA-noSS患者中的126例被统计学提取。RA患者中，重叠SS分别导致达到缓解（由DAS 28-ESR、DAS 28-CRP、SDAI和CDAI定义）的概率降低29%、26%、18%和22%。还观察到达到低疾病活性的类似降低的概率。尽管ESR受影响最显著（HR 0.69，95% CI 0.61-0.79），但复合RA疾病活动评分的其他组分也受到重叠SS的影响。按年龄、RF/ACPA状态或基线DAS 28-CRP分层与结果变化无关。结论重叠SS与RA患者达到缓解或疾病活动度低的可能性有关，应视为RA患者预后不良的因素之一。
Background Overlapping Sjogren's syndrome (SS) is not uncommon in rheumatoid arthritis (RA) and considered as a probable detrimental factor of RA. But data on the impact of overlapping SS on RA therapeutic response is limited. Our current study aimed to identify the effect in a real-world cohort from 2009 to 2019. Methods The medical records of RA patients who visited the rheumatology clinic of our medical center from 2009 to 2019 were reviewed. Their composite disease activity scores at each follow-up point were collected. The therapeutic response between RA patients with SS (RA-SS) and without (RA-noSS) was compared. To correct confounders which may affect the therapeutic response, both propensity score matched and unmatched cohorts were analyzed by using the Cox proportional hazards model. Results Among the 1099 RA patients, 129 (11.7%) overlapped with SS were validated by positive anti-SSA or a minor salivary gland biopsy with histological changes suggestive of SS. After propensity score matching based on their baseline characteristics, 126 of 129 RA-SS and 126 of 970 RA-noSS patients were statistically extracted. Overlapping SS was associated with a 29%, 26%, 18%, and 22% lower probability of reaching remission defined by DAS28-ESR, DAS28-CRP, SDAI, and CDAI in RA patients, respectively. Similar decreased probability of reaching low disease activity was also observed. Although ESR was most significantly affected (HR 0.69, 95% CI 0.61-0.79), other component of composite RA disease activity score was also affected by overlapping SS. Stratification by age, RF/ACPA status, or baseline DAS28-CRP was not associated with change of results. Conclusions Overlapping SS is associated with lower probability of reaching remission or low disease activity in RA patients and should be regarded as one of the poor prognostic factors.