Associations of disease activity and treatments with mortality in men with rheumatoid arthritis: results from the VARA registry
Associations of disease activity and treatments with mortality in men with rheumatoid arthritis: results from the VARA registry
复制标题
DOI：
10.1093/rheumatology/keq232
复制
发表时间：
2011-01-01
期刊：
影响因子：
5.5
通讯作者：
Reimold, Andreas
中科院分区：
文献类型：
--
作者：
Mikuls, Ted R.;Fay, Brian T.;Reimold, Andreas
方法。研究人员招募了患有类风湿性关节炎的男性，并对其进行随访，直至死亡或审查。通过系统记录审查确定生命状态，并使用美国男性生命表计算标准化死亡率（SMRs）。使用多变量Cox比例风险回归来检查患者因素的独立关联，包括社会人口统计学、合并症、RA疾病活动性/严重程度的测量和药物使用与死亡率。RA疾病活动度和药物治疗作为时变因素进行了检查。在2314患者年的随访期间，共观察到138例死亡（n = 1015例患者），对应的粗死亡率为每100患者年5.9例死亡（95% CI 5.0, 7.0）， SMR为2.1 （95% CI 1.8, 2.5）。多因素调整后，与男性RA患者较高死亡风险独立相关的因素包括：年龄较大、高加索人种、低体重、风湿病就诊频率增加、ESR和RF浓度较高、DAS28升高、皮下结节和强的松使用。相比之下，MTX的使用[风险比（HR） 0.63；95%可信区间（CI） 0.42, 0.96)与死亡率降低40%相关。患有类风湿性关节炎的美国男性退伍军人的死亡率是普通人群中同龄男性的两倍多。这些结果表明，优化疾病控制，特别是包括甲氨蝶呤和最小化糖皮质激素暴露的方案，可以提高该人群的长期生存率。
Methods. Men with RA were enrolled and followed until death or censoring. Vital status was ascertained through systematic record review and standardized mortality ratios (SMRs) were calculated using US life tables for men. Multivariate Cox proportional hazards regression was used to examine the independent associations of patient factors including socio-demographics, comorbidity, measures of RA disease activity/severity and medication use with mortality. Measures of RA disease activity and medications were examined as time-varying factors.Results. A total of 138 deaths were observed during 2314 patient-years of follow-up (n = 1015 patients), corresponding to a crude morality rate of 5.9 deaths per 100 patient-years (95% CI 5.0, 7.0) and an SMR of 2.1 (95% CI 1.8, 2.5). After multivariate adjustment, factors independently associated with higher mortality risk in men with RA included older age, Caucasian race, low body weight, an increased frequency of rheumatology visits, higher ESR and RF concentrations, increased DAS28, subcutaneous nodules and prednisone use. In contrast, MTX use [hazard ratio (HR) 0.63; 95% CI 0.42, 0.96] was associated with similar to 40% lower mortality risk.Conclusion. Mortality rates among US male veterans with RA are more than twice those of age-matched men in the general population. These results suggest that optimizing disease control, particularly with regimens that include MTX and minimize glucocorticoid exposure, could improve long-term survival in this population.