Factors associated with gastrointestinal perforation in a cohort of patients with rheumatoid arthritis.
Factors associated with gastrointestinal perforation in a cohort of patients with rheumatoid arthritis.
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DOI：
10.1002/acr.21764
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发表时间：
2012-12
影响因子：
4.7
通讯作者：
Schulman, Kathy L.
中科院分区：
文献类型：
--
作者：
Curtis, Jeffrey R.;Lanas, Angel;John, Ani;Johnson, David A.;Schulman, Kathy L.
评估类风湿关节炎（RA）患者胃肠道（GI）穿孔的发生率和危险因素。雇主健康保险计划的索赔用于识别RA患者和因上消化道穿孔或下消化道穿孔住院的患者。使用敏感和特异性定义识别GI穿孔病例。使用固定和随时间变化的协变量的考克斯模型评价GI穿孔的风险。在143，433例RA患者中，使用最敏感的GI穿孔定义，确定了696例穿孔住院。穿孔率为1.70/1000人年（PY）[95% CI，1.58-1.83]，大多数穿孔（83%）发生在下胃肠道。当使用更具体的GI穿孔定义时，穿孔率较低（0.87，95% CI，0.78-0.96/1，000 PY）。年龄和憩室炎是穿孔的最强风险因素（对于更敏感的定义，憩室炎风险比=14.5 [95% CI，11.8-17.7]，对于更具体的定义，风险比=3.9 [95% CI，2.5-5.9]）。在各种RA药物组中，与甲氨蝶呤相比，暴露于伴随非生物疾病缓解抗风湿药物和糖皮质激素的患者中GI穿孔的风险最高。无糖皮质激素暴露的生物制剂不是穿孔的风险因素。胃肠道穿孔是一种罕见但严重的疾病，影响RA患者，最常见于下胃肠道。临床医生在管理RA患者时应了解GI穿孔的风险因素，包括年龄、憩室炎病史和糖皮质激素或NSAID的使用。
To estimate the incidence and risk factors for gastrointestinal (GI) perforation among patients with rheumatoid arthritis (RA). Claims from employer health insurance plans were used to identify RA patients and those hospitalized for upper or lower GI perforation. GI perforation cases were identified using both a sensitive and specific definition. A Cox model using fixed and time-varying covariates was used to evaluate risk of GI perforation. Among 143,433 RA patients, and using a maximally sensitive GI perforation definition, 696 hospitalizations with perforation were identified. The rate of perforation was 1.70 per 1000 person years (PYs) [95% CI, 1.58–1.83] and most perforations (83%) occurred in the lower GI tract. The rate of perforation was lower when a more specific GI perforation definition was used (0.87, 95% CI, 0.78–0.96 per 1,000 PYs). Age and diverticulitis were among the strongest risk factors for perforation (diverticulitis hazard ratio=14.5 [95% CI, 11.8–17.7] for more sensitive definition, hazard ratio=3.9 [95% CI, 2.5–5.9] for more specific definition). Among various RA medication groups, and compared to methotrexate, the risk of GI perforation was highest among patients with exposure to concomitant non-biologic disease-modifying antirheumatic drugs and glucocorticoids. Biologics without glucocorticoid exposure was not a risk factor for perforation. GI perforation is a rare but serious condition that affects patients with RA, most frequently in the lower GI tract. Clinicians should be aware of risk factors for GI perforation when managing RA patients, including age, history of diverticulitis, and use of glucocorticoids or NSAIDs.
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影响因子：
2.4
作者：
Straube S;Tramèr MR;Moore RA;Derry S;McQuay HJ
通讯作者：
McQuay HJ
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