Tengstrand Birgitta, Ahlmén Monica, Hafström Ingiäld
Department of Rheumatology, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden.
J Rheumatol. 2004 Feb;31(2):214-22.
This prospective study analyzed influence of patient's sex on early rheumatoid arthritis (RA) within one year of disease onset and after 2 years' followup.
A total of 844 consecutive patients, 538 women, with RA of less than 12 months were studied. Standardized clinical and radiographic assessments were performed at study entry and after 2 years. The association of several variables at study entry with the outcome variables Disease Activity Score (DAS28), functional disability measured by the Health Assessment Questionnaire (HAQ), and, in 390 patients, Larsen score at the 2-year followup were analyzed in men and women separately.
At study entry the women were younger compared with the men and the sexes showed different age distributions. The women had higher DAS28 and HAQ scores. However, women below 50 years of age at study entry had milder disease than older women and close to that of men. At 2-year followup the women still had higher DAS28 and HAQ scores compared to men, who had achieved remission in a higher frequency. Larsen score showed no sex difference either at study entry or after 2 years. Presence of rheumatoid factor (RF) was associated with lower age at study entry and higher DAS28 at followup in men only. Higher DAS28 and HAQ scores at entry were more strongly correlated with severe disease at followup in women than in men. Presence of the "shared epitope" was not associated with age or the outcome variables DAS28 and Larsen score in either sex.
The disease phenotype in early RA was significantly different between men and women, particularly concerning age, disease activity, and functional capacity. There were differences between the sexes concerning early disease characteristics associated with outcome at 2 years of followup.
本前瞻性研究分析了患者性别对疾病发作一年内及随访2年后早期类风湿关节炎（RA）的影响。
共研究了844例病程少于12个月的连续性RA患者，其中女性538例。在研究开始时和2年后进行标准化临床和影像学评估。分别分析了男性和女性在研究开始时几个变量与结局变量疾病活动评分（DAS28）、通过健康评估问卷（HAQ）测量的功能残疾以及在390例患者中2年随访时的 Larsen 评分之间的关联。
研究开始时，女性比男性年轻，且两性年龄分布不同。女性的DAS28和HAQ评分更高。然而，研究开始时年龄低于50岁的女性疾病比年长女性轻，且接近男性。2年随访时，女性的DAS28和HAQ评分仍高于男性，而男性缓解频率更高。Larsen评分在研究开始时和2年后均无性别差异。类风湿因子（RF）的存在仅与男性研究开始时较低年龄和随访时较高DAS28相关。与男性相比，女性研究开始时较高的DAS28和HAQ评分与随访时的严重疾病相关性更强。“共享表位”的存在与两性的年龄或结局变量DAS28和Larsen评分均无关。
早期RA的疾病表型在男性和女性之间存在显著差异，特别是在年龄、疾病活动和功能能力方面。两性在与2年随访结局相关的早期疾病特征方面存在差异。
