老年患者血清阳性类风湿关节炎发病时影像学损伤评分增加与手部骨关节炎相关，但与损伤进展更快无关。

Increased radiographic damage scores at the onset of seropositive rheumatoid arthritis in older patients are associated with osteoarthritis of the hands, but not with more rapid progression of damage.

作者信息

Khanna Dinesh, Ranganath Veena K, Fitzgerald John, Park Grace S, Altman Roy D, Elashoff David, Gold Richard H, Sharp John T, Furst Daniel E, Paulus Harold E

机构信息

University of California at Los Angeles, USA.

出版信息

Arthritis Rheum. 2005 Aug;52(8):2284-92. doi: 10.1002/art.21221.

DOI:10.1002/art.21221

PMID:16052588

Abstract

OBJECTIVE

To investigate the impact of patient age at symptom onset on radiographic joint damage at study entry, and on subsequent progression of damage in a cohort of patients with early seropositive rheumatoid arthritis (RA).

METHODS

We studied 186 patients with RA of <15 months' duration. All patients had active disease and had not received disease-modifying antirheumatic drugs. At study entry and during followup, total Sharp scores (TSS), RA-associated joint space narrowing (RA-JSN), and erosions were determined on hand and foot radiographs. Baseline radiographs were also scored for osteoarthritis (OA)-related JSN (OA-JSN) and osteophytes. Older patients (>55 years) and younger patients (</=55 years) were compared by t-test, Mann-Whitney U test, chi-square, or Fisher's exact test. Multiple linear regression models were also constructed.

RESULTS

The older group (n = 74) had a higher baseline total Sharp score (median 6.21) compared with the younger group (n = 112) (median 2.33) (P = 0.0002). This was mainly due to a higher baseline JSN score in the older group (median 3.96 versus 1.08) and not to differences in erosion score (median 0.91 versus 0.70). Disease activity and duration of RA symptoms were similar in the 2 groups, as were progression rates of the TSS, JSN score, and erosion score. At baseline, 26% of patients had osteophytes, with a prevalence of 13% in the younger age group and 50% in the older group. The presence of OA-JSN was highly correlated with the presence of osteophytes (r = 0.72). Also, increased age and RA-JSN were associated with increased severity of osteophytes and OA-JSN at baseline. Multiple linear regression analysis showed that both age and hand osteophytes contributed to the increase in baseline RA-JSN score and TSS, but not to erosion score.

CONCLUSION

In a cohort of patients with early RA, an increase in the baseline RA-JSN score and TSS can be accounted for in part by the presence of hand OA.

摘要

目的

探讨症状出现时患者年龄对早期血清学阳性类风湿关节炎（RA）患者入组时影像学关节损伤以及随后损伤进展的影响。

方法

我们研究了186例病程小于15个月的RA患者。所有患者均患有活动性疾病且未接受改善病情抗风湿药物治疗。在入组研究时及随访期间，对手部和足部X线片进行总Sharp评分（TSS）、类风湿关节炎相关关节间隙狭窄（RA-JSN）及骨侵蚀情况的评估。还对基线X线片的骨关节炎（OA）相关关节间隙狭窄（OA-JSN）及骨赘进行评分。采用t检验、Mann-Whitney U检验、卡方检验或Fisher精确检验对老年患者（>55岁）和年轻患者（≤55岁）进行比较。还构建了多元线性回归模型。

结果

老年组（n = 74）的基线总Sharp评分（中位数6.21）高于年轻组（n = 112）（中位数2.33）（P = 0.0002）。这主要是由于老年组基线JSN评分较高（中位数3.96对1.08），而非骨侵蚀评分存在差异（中位数0.91对0.70）。两组的疾病活动度及RA症状持续时间相似，TSS、JSN评分及骨侵蚀评分的进展率也相似。基线时，26%的患者有骨赘，年轻年龄组患病率为13%，老年组为50%。OA-JSN的存在与骨赘的存在高度相关（r = 0.72）。此外，年龄增加和RA-JSN与基线时骨赘及OA-JSN的严重程度增加相关。多元线性回归分析显示，年龄和手部骨赘均导致基线RA-JSN评分和TSS升高，但不影响骨侵蚀评分。