Is the disease course of rheumatoid arthritis becoming milder?
Is the disease course of rheumatoid arthritis becoming milder?
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DOI：
10.1002/art.21259
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发表时间：
2005-09-01
影响因子：
--
通讯作者：
van Riel, PLCM
中科院分区：
文献类型：
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作者：
Welsing, PMJ;Fransen, J;van Riel, PLCM
目标。基于不同历时患者的短期队列研究或横断面样本的比较，有人认为，与过去几十年的患者相比，现在的类风湿关节炎(RA)患者的病程较轻。本研究旨在调查类风湿性关节炎患者的疾病活动性和功能障碍的病程在过去几年中是否有所减轻。我们使用奈梅亨早期类风湿关节炎的初始队列，包括自1985年以来在拉德布大学奈梅亨医学中心风湿科就诊的所有新诊断的类风湿关节炎患者。患者每3个月接受28个关节疾病活动评分(DAS28)，每6个月采用健康评估问卷(HAQ)残疾指数(DI)评估功能障碍。在总队列中，根据纳入患者的日期(1985-1990年、1990-1995年、1995-2000年、2000-2005年)定义了4个子队列。为了研究疾病活动度和功能障碍的病程(随时间变化)在亚队列之间是否不同，采用纵向回归分析(线性混合模型)，分别以DAS28和HAQ DI随时间变化作为结果变量，并将亚队列作为自变量，校正了基线人口学和临床特征。比较不同亚队列患者的治疗策略。在最近的亚队列中，基线和疾病前5年的DAS28较低。HAQ功能障碍没有显示出改善，反而有恶化功能障碍的趋势。使用纵向回归显示，疾病活动在病程早期得到改善，之后趋于稳定，而且这种改善在较新的亚队列中的患者和基线DAS28较高的患者中更明显。最初，HAQ DI也有所改善，但此后稳定下来，这种最初的改善在较新的亚队列患者中不那么明显，而在基线HAQ DI较高的患者中更明显。治疗策略在最近的亚队列中更具侵略性，表现为从诊断到开始使用强的松或抗风湿药物(DMARD)的时间更短，DMARD治疗的流行率更高。近年来，类风湿性关节炎患者的疾病活动病程变得较轻。这种改善趋势的原因仍有待阐明，尽管这一趋势与更积极的治疗策略不谋而合。
Objective. Based on comparisons of short-term cohort studies or cross-sectional samples of patients from different calendar times, it has been suggested that present patients with rheumatoid arthritis (RA) have a milder disease course compared with that of patients in past decades. This study was undertaken to investigate whether the course of disease activity and functional disability in patients with RA has become milder over the past several years.Methods. We used the Nijmegen inception cohort of early RA, which included all patients with newly diagnosed RA who had attended the department of rheumatology at Radboud University Nijmegen Medical Centre since 1985. Patients were assessed for disease activity by the Disease Activity Score in 28 joints (DAS28) every 3 months and for functional disability by the Health Assessment Questionnaire (HAQ) disability index (DI) every 6 months. Within the total cohort, 4 subcohorts were defined, based on the date of inclusion of the patients (1985-1990, 1990-1995, 1995-2000, 2000-2005). To investigate whether the course of disease activity and functional disability (over time) was different between the subcohorts, longitudinal regression analysis (linear mixed models) was used, with the DAS28 and HAQ DI over time as outcome variables, respectively, and subcohort as the independent variable, correcting for baseline demographic and clinical char-acteristics. The treatment strategy was compared between the subcohorts.Results. The DAS28 at baseline and over the first 5 years of disease was lower in the more recent subcohorts. The HAQ DI did not show improvement but instead a trend toward worsening functional disability. Using longitudinal regression it was shown that disease activity improved early in the disease course and stabilized thereafter, and that this improvement was greater in patients in the more recent subcohorts and in patients with a higher baseline DAS28. Initially, the HAQ DI also improved but stabilized thereafter, and this initial improvement was less pronounced in patients in the more recent subcohorts and was greater for patients with a higher baseline HAQ DI. The treatment strategy was more aggressive in the more recent subcohorts, as shown by a shorter duration from diagnosis to the start of treatment with prednisone or disease-modifying antirheumatic drugs (DMARDs), and a greater prevalence of DMARD therapy.Conclusion. The course of disease activity in RA patients has become milder in more recent years. The reason for this improving trend remains to be elucidated, although the trend coincides with a more aggressive treatment strategy.