Jäntti Juha K, Kaarela Kalevi, Belt Eero A, Kautiainen Hannu J
Rheumatism Foundation Hospital, Heinola, Finland.
J Rheumatol. 2002 Apr;29(4):688-92.
Information from successive inception cohorts is needed to reveal changes in the endpoint severity of rheumatoid arthritis (RA). We assessed joint destruction and disability 8-20 years after the onset of RA to estimate the number of patients with severe disease at the endpoint.
Radiographs of the hands and feet were taken at onset and at 1, 3, 8, 15, and 20 years from entry among 103 patients with recent onset (< 6 mo) seropositive RA. The Larsen score of 0-100 of 20 joints of hands and feet, the Health Assessment Questionnaire (HAQ) index, and the number of large joint arthroplasties were used to assess severity. The cumulative number of patients with amyloidosis was recorded.
The median progression of small joint destruction was 2-3% yearly. At the endpoint 36% of the patients had Larsen score 50-100 and 23% scored 67-100. The endpoint HAQ index was 2-3 in 16% of the 81 patients investigated. The number of large joint arthroplasties was 29 in 16 patients. A high Larsen score or HAQ was registered in 30 (29%) patients. The incidence of amyloidosis was 13.6%; at the end of the 20 year followup 9 of the 14 patients with amyloidosis had died.
Our prospective 20 year RA study is the first epidemiological survey in which 20 year severity in RA has been determined by 4 clinical measures; these data will serve as a basis for discussion of methods and comparison with other cohorts in the future.
需要连续起始队列的信息来揭示类风湿关节炎（RA）终点严重程度的变化。我们评估了RA发病8至20年后的关节破坏和残疾情况，以估计终点时严重疾病患者的数量。
对103例近期发病（<6个月）血清阳性RA患者在发病时以及入组后1、3、8、15和20年拍摄手和足部X线片。使用手和足部20个关节的Larsen评分（0 - 100）、健康评估问卷（HAQ）指数以及大关节置换术的数量来评估严重程度。记录淀粉样变性患者的累计数量。
小关节破坏的中位进展率为每年2 - 3%。在终点时，36%的患者Larsen评分为50 - 100，23%的患者评分为67 - 100。在81例接受调查的患者中，16%的患者终点HAQ指数为2 - 3。16例患者进行了29次大关节置换术。30例（29%）患者的Larsen评分或HAQ较高。淀粉样变性的发生率为13.6%；在20年随访结束时，14例淀粉样变性患者中有9例死亡。
我们这项为期20年的RA前瞻性研究是首次通过4种临床测量方法确定RA 20年严重程度的流行病学调查；这些数据将作为未来讨论方法以及与其他队列进行比较的基础。
