Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years
Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years
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DOI：
10.1136/ard.62.8.722
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发表时间：
2003-08-01
影响因子：
27.4
通讯作者：
Matteson, EL
中科院分区：
文献类型：
--
作者：
Turesson, C;O'Fallon, WM;Matteson, EL
目的：在一个明确的社区类风湿关节炎（RA）患者队列中调查关节外类风湿关节炎（ExRA）的发病趋势，并研究ExRA发生的可能预测因素。方法：利用罗切斯特流行病学项目的资源，对1955-94年在明尼苏达州奥姆斯特德县诊断的609例RA病例进行了回顾性病历审查。这些病例先前已使用ACR 1987 RA标准进行分类。从1955年至2000年对患者进行随访（中位随访时间为11.8年;范围为0.1-42.8年），并根据预定义的标准记录ExRA的临床表现。按诊断的十年比较RA患者首次出现ExRA的时间。结果：247例患者（40.6%）发生了ExRA。在瑞典马尔莫的既往研究中，78例患者（12.8%）的亚组具有被认为是重度的ExRA表现。重度ExRA的发生率在数十年内没有显著变化（p = 0.165）。在多变量分析中，重度ExRA的主要预测因素为RA诊断时吸烟（风险比（RR）= 2.94; 95%置信区间（95% CI）1.68 - 5.13）和早期残疾（诊断时Steinbrocker III-IV级）（RR = 2.45; 95% CI 1.51 - 4.00）。吸烟的影响压倒了较弱的影响类风湿因子seropositive.Conclusion：有没有减少的发病率关节外的表现在1995年诊断的RA患者。吸烟和早期残疾是关节外RA的独立危险因素。
Objective: To investigate the trends in incidence of extra-articular rheumatoid arthritis (ExRA) in a well defined community based cohort of patients with rheumatoid arthritis (RA), and to examine possible predictors of ExRA occurrence.Methods: Using the resources of the Rochester Epidemiology Project, a retrospective medical record review was conducted of a cohort of 609 cases of RA in Olmsted County, MN, diagnosed during 1955-94. These cases had been previously classified using the ACR 1987 criteria for RA. Patients were followed up from 1955 to 2000 (median follow up 11.8 years; range 0.1-42.8), and incident ExRA manifestations were recorded according to predefined criteria. Time to first presentation of ExRA was compared in patients with RA by decade of diagnosis. Possible ExRA risk factors were identified in case record reviews.Results: ExRA occurred in 247 patients (40.6%). A subgroup of 78 patients (12.8%) had ExRA manifestations considered to be severe in a previous study from Malmo, Sweden. The incidence of severe ExRA did not change significantly over the decades (p = 0.165). In a multivariate analysis the main predictors of severe ExRA were smoking at RA diagnosis ( risk ratio (RR) = 2.94; 95% confidence interval (95% CI) 1.68 to 5.13) and early disability (Steinbrocker class III-IV at diagnosis) (RR = 2.45; 95% CI 1.51 to 4.00). The effect of smoking overwhelmed the weaker effect of rheumatoid factor seropositivity.Conclusion: There was no decrease in the incidence of extra-articular manifestations in patients with RA diagnosed up to 1995. Smoking and early disability are independent risk factors for extra-articular RA.