Gonzalez-Lopez L, Gamez-Nava J I, Jhangri G S, Ramos-Remus C, Russell A S, Suarez-Almazor M E
Healthcare Quality and Outcomes Research Centre, Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
J Rheumatol. 1999 Mar;26(3):540-5.
Palindromic rheumatism is characterized by attacks of acute arthritis of short duration. In the long term, a substantial proportion of patients will develop rheumatoid arthritis (RA) or other connective tissue diseases, but the determinants of subsequent chronic disease have not been adequately established. We identify clinical prognostic factors for the development of RA and other connective tissue diseases in patients with palindromic rheumatism in a retrospective cohort study.
The medical records of 4900 patients with arthritis referred from 1986 to 1996 to 3 rheumatologists at an academic center were reviewed. One hundred sixty patients were diagnosed as having palindromic rheumatism. After review, 127 complied with diagnostic criteria for palindromic rheumatism. Disease duration was estimated as time of first attack until the last consultation, or the development of RA or other connective tissue disease. Survival analysis including Cox regression was used to identify clinical variables associated with the risk of developing RA or other connective tissue disease, adjusting for varying disease duration.
Sixty-five percent of the patients were female. Age at onset was 40+/-12 years. Mean disease duration was 6+/-6 years, and mean followup by the rheumatologists was 40+/-45 months. Joints more frequently affected were wrist, knee, and metacarpophalangeal. Forty-three patients (34%) subsequently developed a connective tissue disease including 36 (28%) RA, 3 (2%) systemic lupus erythematosus, and 4 (3%) other connective tissue diseases. In the final Cox regression model the hazard ratio for development of a connective tissue disease in the presence of a positive rheumatoid factor (RF) was 2.9 (p = 0.002), for proximal interphalangeal (PIP) joint involvement 2.4 (p = 0.02), for wrist involvement 2.5 (p = 0.05), for female sex 2.2 (p = 0.05), and for age at onset 1.03 (per year) (p = 0.001). Female patients with positive RF and involvement of the hands had an 8-fold risk of developing disease, compared with patients with one or fewer of these features.
Positive RF and early involvement of the wrist and PIP joints predict the subsequent development of RA or other connective tissue disease in patients with palindromic rheumatism, and identify a group of patients at increased risk.
回纹型风湿症的特点是急性关节炎发作，病程短暂。从长远来看，相当一部分患者会发展为类风湿关节炎（RA）或其他结缔组织病，但后续慢性病的决定因素尚未完全明确。我们在一项回顾性队列研究中，确定回纹型风湿症患者发生RA和其他结缔组织病的临床预后因素。
回顾了1986年至1996年转诊至某学术中心3位风湿病学家处的4900例关节炎患者的病历。160例患者被诊断为回纹型风湿症。经过复查，127例符合回纹型风湿症的诊断标准。疾病持续时间估计为首次发作至最后一次会诊的时间，或RA或其他结缔组织病的发病时间。采用包括Cox回归在内的生存分析，以确定与发生RA或其他结缔组织病风险相关的临床变量，并对不同的疾病持续时间进行校正。
65%的患者为女性。发病年龄为40±12岁。平均病程为6±6年，风湿病学家的平均随访时间为40±45个月。较常受累的关节为腕关节、膝关节和掌指关节。43例患者（34%）随后发展为结缔组织病，其中36例（28%）为RA，3例（2%）为系统性红斑狼疮，4例（3%）为其他结缔组织病。在最终的Cox回归模型中，类风湿因子（RF）阳性时发生结缔组织病的风险比为2.9（p = 0.002），近端指间关节（PIP）受累时为2.4（p = 0.02），腕关节受累时为2.5（p = 0.05），女性为2.2（p = 0.05），发病年龄为1.03（每年）（p = 与具有这些特征之一或更少的患者相比，RF阳性且手部受累的女性患者发病风险高8倍。
RF阳性以及腕关节和PIP关节早期受累可预测回纹型风湿症患者随后发生RA或其他结缔组织病，并识别出一组风险增加的患者。
