Kuiper S, van Gestel A M, Swinkels H L, de Boo T M, da Silva J A, van Riel P L
Department of Rheumatology, University Medical Center Nijmegen, The Netherlands.
J Rheumatol. 2001 Aug;28(8):1809-16.
To investigate the influences of the menopausal state, sex, and age on the course and outcome of rheumatoid arthritis (RA).
A cohort of patients with early RA (209 female, 123 male) was studied. Sex, age, and menopausal state at baseline, and disease activity, radiographic joint destruction, and physical disability during 6 years of followup were assessed.
The Disease Activity Score (DAS) was significantly higher in female compared to male patients at any time point except at the time of inclusion. This was mainly due to postmenopausal patients. Radiographic joint destruction (RJD) was significantly worse in female patients compared to males at the time of inclusion. Postmenopausal patients had significantly higher RJD than premenopausal patients at the time of inclusion and 3 years thereafter. Older male patients showed worse RJD than younger male patients at all time points measured. Physical disability was significantly worse in female compared to male patients, as well as in postmenopausal compared to premenopausal patients, and older male compared to younger male patients. Stepwise regression analysis revealed that at 3 years higher age and female sex were the best predictors for a worse DAS. Higher age and the interaction term between menopausal state and age best predicted higher RJD. Higher age and the interaction term between menopausal state and age best predicted Health Assessment Questionnaire (HAQ) score.
Higher age at presentation of RA leads to a more severe disease course in terms of DAS, RJD, and HAQ. Although female sex has a deteriorating effect on the DAS, the menopausal state is responsible for the major part of the differences in outcome between men and women. Postmenopausal state in early RA influences future disability and damage, especially in older patients.
探讨绝经状态、性别和年龄对类风湿关节炎（RA）病程及结局的影响。
对一组早期RA患者（209名女性，123名男性）进行研究。评估基线时的性别、年龄和绝经状态，以及随访6年期间的疾病活动度、影像学关节破坏情况和身体残疾程度。
除纳入时外，在任何时间点女性患者的疾病活动评分（DAS）均显著高于男性患者。这主要归因于绝经后患者。在纳入时，女性患者的影像学关节破坏（RJD）明显比男性更严重。纳入时及之后3年，绝经后患者的RJD显著高于绝经前患者。在所有测量时间点，老年男性患者的RJD均比年轻男性患者更严重。女性患者的身体残疾程度明显比男性更严重，绝经后患者比绝经前患者更严重，老年男性比年轻男性更严重。逐步回归分析显示，3年时年龄较大和女性性别是DAS较差的最佳预测因素。年龄较大以及绝经状态与年龄的交互项是RJD较高的最佳预测因素。年龄较大以及绝经状态与年龄的交互项是健康评估问卷（HAQ）评分的最佳预测因素。
RA发病时年龄较大，在DAS、RJD和HAQ方面会导致更严重的疾病进程。尽管女性性别对DAS有恶化作用，但绝经状态是男女结局差异的主要原因。早期RA中的绝经后状态会影响未来的残疾和损害，尤其是在老年患者中。
