Incidence and Time Trends of Herpes Zoster in Rheumatoid Arthritis: A Population-Based Cohort Study
Incidence and Time Trends of Herpes Zoster in Rheumatoid Arthritis: A Population-Based Cohort Study
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DOI：
10.1002/acr.21928
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发表时间：
2013-06-01
影响因子：
4.7
通讯作者：
Crowson, Cynthia S.
中科院分区：
文献类型：
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作者：
Veetil, Bharath Manu Akkara;Myasoedova, Elena;Crowson, Cynthia S.
目的确定以人群为基础的新诊断类风湿关节炎(RA)患者与同一人群中非RA患者的带状疱疹的发病率、时间趋势、危险因素和严重程度。方法收集1980年1月1日至2007年12月31日首次符合1987年美国风湿病学会RA诊断标准的明尼苏达州奥姆斯特德县的所有居民和一组相似的非RA居民，进行病历回顾，直至死亡、迁徙或2008年12月31日。结果在类风湿性关节炎发病/指数日期之前，两组人群带状疱疹的发生率无显著差异(P=0.85)。在随访期间，84例RA患者(12.1例/1000人年)和44例非RA患者(5.4例/1000人年)发生带状疱疹。类风湿性关节炎患者比非类风湿性关节炎患者更容易发生带状疱疹(风险比[HR]2.4[95%可信区间(95%CI)1.7-3.5])。带状疱疹在最近被诊断为RA的患者中发生得更频繁(HR每年1.06[95%CI 1.02-1.10])。腐蚀性疾病、既往关节手术、羟氯喹和皮质类固醇的使用与RA带状疱疹的发生显著相关。带状疱疹与甲氨蝶呤或生物制剂的使用没有明显的关联。带状疱疹并发症在两组人群中的发生率相似。结论带状疱疹在类风湿关节炎中的发病率呈上升趋势，且近年来呈上升趋势。近年来，带状疱疹在普通人群中的发病率也有所上升。类风湿性关节炎的严重程度与带状疱疹的发生有关。
Objective To determine the incidence, time trends, risk factors, and severity of herpes zoster in a population-based cohort of patients with newly diagnosed rheumatoid arthritis (RA) compared to a group of individuals without RA from the same population. Methods All residents of Olmsted County, Minnesota fulfilling for the first time the 1987 American College of Rheumatology criteria for RA between January 1, 1980 and December 31, 2007 and a cohort of similar residents without RA were assembled and followed by retrospective chart review until death, migration, or December 31, 2008. Results There was no difference in the presence of herpes zoster prior to the RA incidence/index date between the cohorts (P = 0.85). During followup, 84 patients with RA (rate 12.1 cases per 1,000 person-years) and 44 subjects without RA (rate 5.4 cases per 1,000 person-years) developed herpes zoster. Patients with RA were more likely to develop herpes zoster than those without RA (hazard ratio [HR] 2.4 [95% confidence interval (95% CI) 1.7-3.5]). Herpes zoster occurred more frequently in patients diagnosed with RA more recently (HR 1.06 per year [95% CI 1.02-1.10]). Erosive disease, previous joint surgery, and use of hydroxychloroquine and corticosteroids were significantly associated with the development of herpes zoster in RA. There was no apparent association of herpes zoster with the use of methotrexate or biologic agents. Complications of herpes zoster occurred at a similar rate in both cohorts. Conclusion The incidence of herpes zoster is increased in RA and has risen in recent years. There also has been an increasing incidence of herpes zoster in more recent years in the general population. RA disease severity is associated with the development of herpes zoster.