Ali Yaser, Tom Brian D M, Schentag Catherine T, Farewell Vernon T, Gladman Dafna D
University of Toronto, and Toronto Western Hospital, Toronto, Ontario, Canada.
Arthritis Rheum. 2007 Aug;56(8):2708-14. doi: 10.1002/art.22800.
To determine whether there has been a change in mortality rates over the last 3 decades in patients with psoriatic arthritis (PsA) whose cases were followed prospectively.
Patients receiving followup care according to a standard protocol at the University of Toronto PsA Clinic between 1978 and 2004 were included. Information on patient deaths was collected prospectively. Mortality data for the general population of Ontario, Canada, stratified by 5-year age bands, sex, and calendar year from 1978 to 2004, were used to calculate the reference rates. Standardized mortality ratios (SMRs) were calculated through use of Poisson regression models for the number of observed deaths. Time trend analyses were performed through the use of 10-year "rolling-average" SMRs and followup period-specific SMRs stratified by the period of entry into clinic.
Of 680 patients with PsA, 106 (15.6%) (55 women and 51 men) have died. Major causes of death were disease of the circulatory system, neoplasms, diseases of the respiratory system, diseases of the gastrointestinal system, injuries/poisoning, and unknown. The overall SMR for the period 1978-2004 was 1.36 (95% confidence interval 1.12, 1.64). The estimated number of life-years lost by the PsA patient cohort overall was 2.99 years (95% confidence interval 1.14, 4.77). For patients who entered the cohort during the years 1978-1986, the SMRs were 1.89, 1.83, and 1.21 for followup periods 1978-1986, 1987-1995, and 1996-2004, respectively. For patients who entered the cohort during the years 1987-1995, the SMRs were 0.55 and 0.82, while the SMR for those who entered during 1996-2004 was 0.56.
The drop in SMRs in this PsA clinic population suggests that the mortality risk has improved over time. This improved survival may reflect disease severity at presentation in the earlier cohort as well as earlier diagnosis and more aggressive treatment in the more recent followup period.
确定在过去30年中，前瞻性随访的银屑病关节炎（PsA）患者的死亡率是否发生了变化。
纳入1978年至2004年期间在多伦多大学PsA诊所按照标准方案接受随访治疗的患者。前瞻性收集患者死亡信息。使用1978年至2004年按5岁年龄组、性别和日历年分层的加拿大安大略省总人口的死亡率数据来计算参考率。通过使用泊松回归模型计算观察到的死亡人数的标准化死亡率（SMR）。通过使用10年“滚动平均”SMR和按进入诊所时间分层的随访期特定SMR进行时间趋势分析。
680例PsA患者中，106例（15.6%）（55例女性和51例男性）死亡。主要死亡原因是循环系统疾病、肿瘤、呼吸系统疾病、消化系统疾病、损伤/中毒以及不明原因。1978 - 2004年期间的总体SMR为1.36（95%置信区间1.12，1.64）。PsA患者队列总体估计损失的生命年数为2.99年（95%置信区间1.14，4.77）。对于1978 - 1986年期间进入队列的患者，1978 - 1986年、1987 - 1995年和1996 - 2004年随访期的SMR分别为1.89、1.83和1.21。对于1987 - 1995年期间进入队列的患者，SMR分别为0.55和0.82，而1996 - 2004年期间进入队列的患者的SMR为0.56。
该PsA诊所人群中SMR的下降表明随着时间推移死亡风险有所改善。这种生存率的提高可能反映了早期队列中疾病的严重程度，以及近期随访期内更早的诊断和更积极的治疗。
