Co-morbidity in patients with early rheumatoid arthritis - inflammation matters.
Co-morbidity in patients with early rheumatoid arthritis - inflammation matters.
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DOI：
10.1186/s13075-016-0928-y
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发表时间：
2016-01-28
影响因子：
4.9
通讯作者：
Wållberg-Jonsson S
中科院分区：
文献类型：
--
作者：
Innala L;Sjöberg C;Möller B;Ljung L;Smedby T;Södergren A;Magnusson S;Rantapää-Dahlqvist S;Wållberg-Jonsson S
类风湿性关节炎（RA）患者患有合并症，导致寿命缩短。炎症对于心血管疾病的发展是重要的，但对其与其他共病的关系知之甚少。我们研究了炎症在早期类风湿关节炎新合并症发生中的作用。自1995年以来，瑞典北方的所有早期RA患者均被纳入一项关于合并症的前瞻性研究，共纳入950例患者。在本研究进行时，726例患者已患病≥5年。从患者记录中收集关于合并症、临床和实验室疾病活动以及药物治疗的数据，并在RA发作时（T0）和5年后（T5）使用问卷进行进一步验证。在这些患者中，53.2%的患者在发病时有一种或多种合并症，最常见的是：高血压（27.3%）、阻塞性肺疾病（13.9%）、糖尿病（8.0%）、甲状腺功能减退症（6.3%）和恶性肿瘤（5.0%）。5年后，41.0%的患者发生了至少一种新的合并症，最常见的是：高血压（15.1%）、恶性肿瘤（7.6%）、卒中/短暂性脑缺血事故（5.1%）、心肌梗死（4.3%）和骨质疏松症（3.7%）。疾病发作时的年龄，入选时红细胞沉降率（ESR）升高，既往接受过糖皮质激素治疗（GC;所有p < 0.001），关节外RA（前RA; p < 0.01），DAS 28 24个月时的平均年龄（曲线下面积）（p < 0.05）、入选时的既往吸烟史（p = 0.058）和男性（p < 0.01）与T5时的新合并症总体相关。生物制剂治疗（p < 0.05）降低了风险。在多元logistic回归模型中，入选时的ESR（p = 0.036）与5年后的新合并症相关，经年龄、性别、吸烟和GC治疗调整。在类似的模型中，Ex-RA（p < 0.05）与T5时的新合并症相关。在第三个模型中，调整了年龄和性别，新的肺部合并症与入选时的吸烟史相关（p < 0.01），但与ESR无关。早期类风湿关节炎患者在疾病发作时就有大量的合并症，在最初的五年内增加了相当多的新的合并症。疾病活动度的测量与新的共病的发生相关，表明炎症在这种情况下很重要。
Patients with rheumatoid arthritis (RA) suffer from co-morbidities that contribute to a shortened lifespan. Inflammation is important for the development of cardiovascular disease, but little is known on its relationship with other co-morbidities. We investigated the role of inflammation for the development of new comorbidities in early RA. Since 1995, all patients with early RA in Northern Sweden are included in a prospective study on co-morbidities, with a total of 950 patients being included. At the time for this study, 726 had been ill for ≥5 years. Data on co-morbidities, clinical and laboratory disease activity and pharmacological therapy were collected from patient records and further validated using a questionnaire at RA onset (T0) and after 5 years (T5). Of the patients, 53.2 % of the patients had one or more co-morbidity at onset, the commonest being: hypertension (27.3 %), obstructive pulmonary disease (13.9 %), diabetes (8.0 %), hypothyroidism (6.3 %) and malignancy (5.0 %). After 5 years, 41.0 % had developed at least one new co-morbidity, the most common being: hypertension (15.1 %), malignancy (7.6 %), stroke/transient ischemic accident (5.1 %), myocardial infarction (4.3 %) and osteoporosis (3.7 %). Age at disease onset, a raised erythrocyte sedimentation rate (ESR) at inclusion, previous treatment with glucocorticoids (GC; p < 0.001 for all), extra-articular RA (Ex-RA; p < 0.01), DAS28 (area under the curve) at 24 months (p < 0.05), previous smoking at inclusion (p = 0.058) and male gender (p < 0.01) were associated with a new co-morbidity overall at T5. Treatment with biologics (p < 0.05) reduced the risk. In multiple logistic regression modelling, ESR (p = 0.036) at inclusion was associated with a new co-morbidity after 5 years, adjusted for age, sex, smoking and GC treatment. In a similar model, Ex-RA (p < 0.05) was associated with a new co-morbidity at T5. In a third model, adjusted for age and sex, a new pulmonary co-morbidity was associated with a smoking history at inclusion (p < 0.01), but not with ESR. There was substantial co-morbidity among early RA patients already at disease onset, with considerable new co-morbidity being added during the first five years. Measures of disease activity were associated with the occurrence of a new co-morbidity indicating that the inflammation is of importance in this context.