Twenty-Year Outcome and Association Between Early Treatment and Mortality and Disability in an Inception Cohort of Patients With Rheumatoid Arthritis Results From the Norfolk Arthritis Register
Twenty-Year Outcome and Association Between Early Treatment and Mortality and Disability in an Inception Cohort of Patients With Rheumatoid Arthritis Results From the Norfolk Arthritis Register
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DOI：
10.1002/art.40090
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发表时间：
2017-08-01
影响因子：
13.3
通讯作者：
Verstappen, Suzanne M. M.
中科院分区：
文献类型：
--
作者：
Gwinnutt, James M.;Symmons, Deborah P. M.;Verstappen, Suzanne M. M.
客观的。描述类风湿性关节炎 (RA) 患者从症状出现起 20 多年的结果，并评估早期治疗（使用缓解疾病的抗风湿药物/类固醇）与随访期间死亡率和残疾之间的关联。方法。 1990 年至 1994 年间招募到诺福克关节炎登记册 (NOAR) 且基线时符合 2010 年美国风湿病学会/欧洲抗风湿病联盟 RA 标准的患者均纳入本次分析。在基线以及第 1-3 年、第 5 年、第 7 年、第 10 年、第 15 年和第 20 年收集人口统计学和临床变量。确定疾病活动性（肿胀关节计数 [SJC]/压痛关节计数 [TJC]）、残疾（健康评估问卷残疾指数 [HAQ DI]）和 20 年以上的死亡率。分别使用加权汇总逻辑回归和加权多级混合效应线性回归评估治疗组（早期治疗[ET]，症状出现后6个月治疗；从未治疗[NT]，不治疗）与死亡率和残疾之间的关联。使用逆权重来解释指示和审查的混杂。结果。这项研究包括 602 名 RA 患者（中位年龄 56 岁[四分位距 44-68 岁]；65.9% 为女性）。随访期间 SJC 和 TJC 中位数较低（1-3 个关节肿胀，3-6 个关节压痛）。第 1 年之后，HAQ DI 分数中位数有所增加，但仍保持在低/中等水平（第 10 年之后，中位数为 1.25）。与 NT 组相比，ET 和 LT 组的死亡风险降低。 ET 组和 NT 组在随访期间的 HAQ DI 评分相当（β=0.03，95% 置信区间 [95% CI] -0.06，0.12），而 LT 组的 HAQ DI 评分有所增加（LT 与 NT 相比，β=0.10 [95% CI 0.02，0.17]）。结论。这项研究的结果表明早期治疗对于 RA 患者的长期结局非常重要。
Objective. To describe the outcome in patients with rheumatoid arthritis (RA) over 20 years from symptom onset, and to assess the association between early treatment (with disease-modifying antirheumatic drugs/steroids) and mortality and disability during follow-up.Methods. Patients recruited to the Norfolk Arthritis Register (NOAR) between 1990 and 1994 who met the 2010 American College of Rheumatology/European League Against Rheumatism RA criteria at baseline were included in this analysis. Demographic and clinical variables were collected at baseline and at years 1-3, 5, 7, 10, 15, and 20. Disease activity (swollen joint count [SJC]/tender joint count [TJC]), disability (Health Assessment Questionnaire disability index [HAQ DI]), and mortality over 20 years were determined. Associations between treatment group (early treatment [ET], treatment 6 months after symptom onset; never treatment [NT], no treatment) and mortality and disability were assessed using weighted pooled logistic regression and weighted multilevel mixed-effects linear regression, respectively. Inverse weights were used to account for confounding by indication and censoring.Results. This study included 602 patients with RA (median age 56 years [interquartile range 44-68 years]; 65.9% women). The median SJCs and TJCs were low during the follow-up period (1-3 swollen joints and 3-6 tender joints). The median HAQ DI score increased after year 1 but remained at low/moderate levels (median 1.25 after year 10). The risk of mortality was reduced in the ET and LT groups compared with that in the NT group. The ET group and the NT group had comparable HAQ DI scores during the follow-up period (beta=0.03, 95% confidence interval [95% CI] -0.06, 0.12), while the HAQ DI score was increased in the LT group (for LT versus NT, beta=0.10 [95% CI 0.02, 0.17]).Conclusion. The results of this study indicate the importance of early treatment with regard to the long-term outcomes in patients with RA.