Progression of radiographic joint damage in different eras: trends towards milder disease in rheumatoid arthritis are attributable to improved treatment
Progression of radiographic joint damage in different eras: trends towards milder disease in rheumatoid arthritis are attributable to improved treatment
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DOI：
10.1136/ard.2005.049338
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发表时间：
2006-09-01
影响因子：
27.4
通讯作者：
Wolfe, F.
中科院分区：
文献类型：
--
作者：
Finckh, A.;Choi, H. K.;Wolfe, F.
背景资料：类风湿性关节炎的严重程度和放射性关节损伤的进展在过去的几十年中有所下降。目的：研究这种趋势是否归因于疾病的轻微趋势或治疗的改善。方法：该研究使用了在美国堪萨斯威奇托的威奇托关节炎中心就诊的早期类风湿性关节炎患者的初始队列，自1973年以来，通过临床、放射学、实验室、人口统计学和自我报告的数据，从他们第一次诊所就诊起进行前瞻性监测。使用纵向数据的多元回归模型比较了20世纪70年代、80年代和90年代发病的患者的放射学疾病进展。该分析调整了基线预测因素，疾病修饰抗风湿药物（DMARDs）和类固醇使用的差异。结果：418例类风湿关节炎患者的放射学随访。在早期几十年的患者使用较少的DMARD，有较长的疾病持续时间和较高的招标关节计数在他们的第一次访问。疾病进展的其他重要预测因素在疾病发作的几十年之间没有显著差异。未校正的放射学进展率在不同年代之间存在差异（方差分析，p = 0.01），近期放射学进展率显著降低（趋势，p < 0.001）。然而，调整DMARD使用，类固醇使用和基线预测因子后，几十年之间的差异消失（方差分析，p = 0.40）和减少放射学进展的趋势消失（趋势，p = 0.45）。结论：这些结果表明，观察到的类风湿性关节炎病情较轻的趋势是由于更有效的抗风湿治疗，而不是长期的趋势。
Background: Severity of rheumatoid arthritis and progression of radiographic joint damage have decreased over the last decades.Aim: To examine whether this trend is attributable to an underlying trend towards milder disease or to improved treatment.Methods: The study used an inception cohort of patients with early rheumatoid arthritis seen at the Wichita Arthritis Center, Wichita, Kansas, USA, since 1973 and monitored prospectively since their first clinic visit through clinical, radiographic, laboratory, demographic and self-reported data. The radiographic disease progression in patients with disease onset in the 1970s, 1980s and 1990s was compared using a multivariate regression model for longitudinal data. The analysis was adjusted for differences in baseline predictors, type of disease-modifying antirheumatic drugs (DMARDs) and steroid use.Results: 418 patients with rheumatoid arthritis with radiographic follow-up were included. Patients in earlier decades used fewer DMARDs, had longer disease durations and higher tender joint counts at their first visit. Other important predictors of disease progression did not differ significantly between decades of disease onset. The unadjusted rates of radiographic progression differed between decades (analysis of variance, p = 0.01), with a significant trend towards less radiographic progression in more recent times (trend, p < 0.001). However, after adjusting for DMARD use, steroid use and baseline predictors, differences between decades vanished (analysis of variance, p = 0.40) and the trend towards less radiographic progression disappeared (trend, p = 0.45).Conclusion: These results suggest that the observed trend towards milder disease in rheumatoid arthritis is attributable to more effective antirheumatic treatment and not to a secular trend.