West Elisabet, Wållberg-Jonsson Solveig
Department of Rheumatology, University Hospital of Umeå, Umeå, Sweden.
Gend Med. 2009 Dec;6(4):544-54. doi: 10.1016/j.genm.2009.12.001.
Rheumatoid arthritis (RA) is a chronic inflammatory joint disorder that may adversely affect health-related quality of life (HRQoL) both in established and early disease.
In patients with recent onset (<12 months) of RA, this extension of a previous study assessed HRQoL and the effect of disease activity over time.
Consecutive patients with recent onset of RA between March 1996 and November 1998 were followed for 6 years at the Department of Rheumatology of the University Hospital of Umeå in Sweden. Patients were requested to complete the 36-item Short Form (SF-36) Health Survey at 0, 24, 48, and 72 months. Gender differences were examined, and correlations between the SF-36 scales (with higher scores indicating better HRQoL) and data reflecting disease activity were analyzed.
Fifty-one patients, 34 women and 17 men (mean age, 50.6 years; range, 20-78 years), participated in the study; in all, 41 patients completed the SF-36 at both 0 and 72 months. At inclusion (0 months), women reported significantly higher scores for physical role functioning, bodily pain, and social functioning compared with men (all, P < 0.05). At 72 months compared with 0 months, women reported significantly better mental health (P < 0.05), whereas men reported significantly better physical role functioning (P < 0.05), bodily pain (P < 0.01), mental health (P < 0.01), and vitality (P < 0.01). Additionally, at 72 months, the entire patient group rated physical role functioning and social functioning (both, P < 0.05), bodily pain and vitality (both, P < 0.01), and mental health (P < 0.001) as significantly better compared with the inclusion assessment. Overall improvement with time was significantly better for men than for women (P < 0.05). There were limited correlations between SF-36 point disease activity parameters and the SF-36 scores at 0 months (erythrocyte sedimentation rate vs physical functioning, mental health [both, P < 0.05], and bodily pain [P < 0.01]; 28-joint Disease Activity Score vs bodily pain [P < 0.05] and emotional role functioning [P < 0.01]) and at 72 months (C-reactive protein vs physical role functioning [P < 0.05]). Most of the physical subscales at inclusion correlated with the physical component summary (PCS) of the SF-36 questionnaire at 6 years.
At disease onset, women with early RA reported better HRQoL than did their male counterparts. After 6 years, women and especially men both experienced better HRQoL, and no significant gender differences remained in any of the SF-36 scales or values for disease activity parameters. The PCS score at disease onset was the best predictor of the PCS score after 6 years.
类风湿关节炎（RA）是一种慢性炎症性关节疾病，在疾病确诊期和早期均可能对健康相关生活质量（HRQoL）产生不利影响。
在近期发病（<12个月）的类风湿关节炎患者中，本项对先前研究的扩展评估了健康相关生活质量以及疾病活动随时间的影响。
1996年3月至1998年11月期间连续纳入的近期发病的类风湿关节炎患者在瑞典于默奥大学医院风湿病科接受了6年的随访。要求患者在0、24、48和72个月时完成36项简明健康调查问卷（SF-36）。研究了性别差异，并分析了SF-36量表（分数越高表明健康相关生活质量越好）与反映疾病活动的数据之间的相关性。
51例患者参与了研究，其中34例女性和17例男性（平均年龄50.6岁；范围20 - 78岁）；共有41例患者在0和72个月时均完成了SF-36调查。纳入研究时（0个月），女性在身体角色功能、身体疼痛和社会功能方面的得分显著高于男性（均P < 0.05）。与0个月时相比，72个月时女性的心理健康状况显著改善（P < 0.05），而男性在身体角色功能（P < 0.05）、身体疼痛（P < 0.01）、心理健康（P < 0.01）和活力（P < 0.01）方面有显著改善。此外，在72个月时，与纳入评估相比，整个患者组在身体角色功能和社会功能（均P < 0.05）、身体疼痛和活力（均P < 0.01）以及心理健康（P < 0.001）方面均有显著改善。总体而言，男性随时间的改善明显优于女性（P < 0.05）。SF-36疾病活动参数得分与0个月时的SF-36得分之间的相关性有限（红细胞沉降率与身体功能、心理健康[均P < 0.05]以及身体疼痛[P < 0.01]；28个关节疾病活动评分与身体疼痛[P < 0.05]和情感角色功能[P < 0.01]），72个月时（C反应蛋白与身体角色功能[P < 0.05]）。纳入研究时的大多数身体子量表与6年时SF-36问卷的身体成分总结（PCS）相关。
在疾病发作时，早期类风湿关节炎女性的健康相关生活质量优于男性。6年后，女性尤其是男性的健康相关生活质量均有所改善，并且在任何SF-36量表或疾病活动参数值方面均无显著性别差异。疾病发作时的PCS评分是6年后PCS评分的最佳预测指标。
