Gonzalez-Lopez L, Gamez-Nava J I, Jhangri G, Russell A S, Suarez-Almazor M E
Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
J Rheumatol. 2000 Jan;27(1):41-6.
To determine whether the use of antimalarials is associated with a reduction in the risk of developing rheumatoid arthritis (RA) or other connective tissue diseases in patients with palindromic rheumatism.
We conducted a retrospective cohort study based on a review of medical records to evaluate the outcome of patients with palindromic rheumatism referred to an academic center from 1986 to 1996: 113 patients complied with the selection criteria, including diagnostic criteria for palindromic rheumatism and onset of disease since 1980. After adjusting for potential confounders, Kaplan-Meier methods and Cox regression models were used to estimate the risk of developing RA or other connective tissue disease in patients who had received antimalarials compared to those who had not.
Age of disease onset was 40+/-12 yrs, and mean disease duration 4.8+/-4 yrs; two-thirds of the patients were female. Sixty-two (55%) patients received antimalarials, for a mean duration of therapy of 28 mo. Thirty-three (29%) patients developed RA, 3 developed systemic lupus, and 4 developed other connective tissue diseases. Twenty (32%) patients in the antimalarial group developed a secondary disease, compared to 20 (39%) who did not receive therapy. Statistically significant differences were observed comparing time to event in both groups. The estimated median time to development of a chronic disease was 162 months in treated and 56 months in untreated patients. After adjusting for other variables in the Cox regression models, significant risk reduction in the development of a secondary disease was observed for antimalarial use (hazard ratio = 0.24; 95% CI 0.09-0.61). For RA, the risk reduction was 0.19 (95% CI 0.07-0.57). We conducted a sensitivity analysis around our censoring estimates. The risk reduction remained statistically significant, with 0.36 for RA and 0.41 for RA or other connective tissue disease.
Use of antimalarials in patients with palindromic rheumatism is associated with a reduction in the risk of developing subsequent RA or other connective tissue disease.
确定使用抗疟药是否与缓解期风湿症患者患类风湿性关节炎（RA）或其他结缔组织疾病的风险降低相关。
我们基于病历回顾进行了一项回顾性队列研究，以评估1986年至1996年转诊至一个学术中心的缓解期风湿症患者的预后：113名患者符合入选标准，包括缓解期风湿症的诊断标准以及自1980年以来的疾病发作情况。在对潜在混杂因素进行调整后，使用Kaplan-Meier方法和Cox回归模型来估计接受抗疟药治疗的患者与未接受抗疟药治疗的患者患RA或其他结缔组织疾病的风险。
疾病发病年龄为40±12岁，平均病程为4.8±4年；三分之二的患者为女性。62名（55%）患者接受了抗疟药治疗，平均治疗时长为28个月。33名（29%）患者患上了RA，3名患上了系统性红斑狼疮，4名患上了其他结缔组织疾病。抗疟药治疗组中有20名（32%）患者患上了继发性疾病，未接受治疗的患者中有20名（39%）患上了继发性疾病。两组在事件发生时间方面观察到了具有统计学意义的差异。估计接受治疗的患者发展为慢性病中位数时间为162个月，未接受治疗的患者为56个月。在Cox回归模型中对其他变量进行调整后，观察到使用抗疟药可显著降低继发性疾病的发生风险（风险比=0.24；95%置信区间0.09-0.61）。对于RA，风险降低为0.19（95%置信区间0.07-0.57）。我们围绕删失估计进行了敏感性分析。风险降低在统计学上仍然显著，RA为0.36，RA或其他结缔组织疾病为0.41。
缓解期风湿症患者使用抗疟药与降低后续患RA或其他结缔组织疾病的风险相关。
