Sokka T, Kautiainen H, Pincus T, Toloza S, da Rocha Castelar Pinheiro G, Lazovskis J, Hetland M L, Peets T, Immonen K, Maillefert J F, Drosos A A, Alten R, Pohl C, Rojkovich B, Bresnihan B, Minnock P, Cazzato M, Bombardieri S, Rexhepi S, Rexhepi M, Andersone D, Stropuviene S, Huisman M, Sierakowski S, Karateev D, Skakic V, Naranjo A, Baecklund E, Henrohn D, Gogus F, Badsha H, Mofti A, Taylor P, McClinton C, Yazici Y
Jyväskylä Central Hospital, 40620 Jyväskylä, Finland.
Ann Rheum Dis. 2009 Nov;68(11):1666-72. doi: 10.1136/ard.2009.109983. Epub 2009 Jul 30.
To analyse associations between the clinical status of patients with rheumatoid arthritis (RA) and the gross domestic product (GDP) of their resident country.
The Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) cohort includes clinical and questionnaire data from 6004 patients who were seen in usual care at 70 rheumatology clinics in 25 countries as of April 2008, including 18 European countries. Demographic variables, clinical characteristics, RA disease activity measures, including the disease activity score in 28 joints (DAS28), and treatment-related variables were analysed according to GDP per capita, including 14 "high GDP" countries with GDP per capita greater than US$24,000 and 11 "low GDP" countries with GDP per capita less than US$11,000.
Disease activity DAS28 ranged between 3.1 and 6.0 among the 25 countries and was significantly associated with GDP (r = -0.78, 95% CI -0.56 to -0.90, r(2) = 61%). Disease activity levels differed substantially between "high GDP" and "low GDP" countries at much greater levels than according to whether patients were currently taking or not taking methotrexate, prednisone and/or biological agents.
The clinical status of patients with RA was correlated significantly with GDP among 25 mostly European countries according to all disease measures, associated only modestly with the current use of antirheumatic medications. The burden of arthritis appears substantially greater in "low GDP" than in "high GDP" countries. These findings may alert healthcare professionals and designers of health policy towards improving the clinical status of patients with RA in all countries.
分析类风湿关节炎（RA）患者的临床状况与其所在国家国内生产总值（GDP）之间的关联。
类风湿关节炎患者定量标准监测（QUEST - RA）队列纳入了截至2008年4月在25个国家70家风湿病诊所接受常规治疗的6004例患者的临床和问卷调查数据，其中包括18个欧洲国家。根据人均GDP对人口统计学变量、临床特征、RA疾病活动指标（包括28个关节的疾病活动评分（DAS28））以及治疗相关变量进行分析，其中包括14个人均GDP高于24,000美元的“高GDP”国家和11个人均GDP低于11,000美元的“低GDP”国家。
25个国家的疾病活动度DAS28在3.1至6.0之间，且与GDP显著相关（r = -0.78，95%可信区间 -0.56至 -0.90，r² = 61%）。“高GDP”国家和“低GDP”国家之间的疾病活动水平差异很大，远大于患者当前是否正在服用甲氨蝶呤、泼尼松和/或生物制剂所造成的差异。
根据所有疾病指标，在25个主要为欧洲的国家中，RA患者的临床状况与GDP显著相关，与当前抗风湿药物的使用仅有适度关联。“低GDP”国家中关节炎的负担似乎比“高GDP”国家大得多。这些发现可能会提醒医疗保健专业人员和卫生政策制定者关注改善所有国家RA患者的临床状况。
