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北美原住民人群中的类风湿关节炎:纵向随访及与白人人群的比较。

Rheumatoid arthritis in a north american native population: longitudinal followup and comparison with a white population.

机构信息

Department of Medicine, Immunology, and the Section of Rheumatology, University of Manitoba, Winnipeg, Manitoba, Canada.

出版信息

J Rheumatol. 2010 Aug 1;37(8):1589-95. doi: 10.3899/jrheum.091452. Epub 2010 Jun 15.

Abstract

OBJECTIVE

To describe differences in phenotype and outcomes in North American Native (NAN) patients with rheumatoid arthritis (RA) followed prospectively and compared to white patients with RA.

METHODS

Patients from a single academic center were followed over 20 years using a custom database. Data included diagnoses, year of disease onset, ethnicity, modified Health Assessment Questionnaire (mHAQ) score, patient and physician global scores, tender and swollen joint counts, treatment, serology, and erythrocyte sedimentation rate (ESR). Records of all white (n = 1315) and NAN (n = 481) patients with RA were abstracted. Cumulative treatment data and clinical measures were compared.

RESULTS

Disease duration was longer in white patients compared to NAN patients (16 +/- 11 vs 14 +/- 10 years, respectively; p = 0.03). Onset age was 34 years for NAN patients and 43 years for white patients (p < 0.001). NAN patients were more frequently positive for rheumatoid factor (89% vs 74%; p < 0.001) and antinuclear antibody (57% vs 21%; p < 0.001). Although mean tender joint counts and swollen joint counts were similar, NAN patients had higher Lansbury scores (weighted joint count; 66.5 vs 49.7; p < 0.001), mHAQ scores (1.1 vs 0.9; p = 0.001), and ESR (31 vs 25 mm/h; p < 0.012). NAN patients had more frequent knee (53% vs 34%; p < 0.001) and elbow (62% vs 48%; p = 0.007) involvement. Compared to white patients, NAN patients took a higher lifetime number of disease-modifying antirheumatic drugs (3.2 +/- 1.9 vs 2.2 +/- 1.7; p < 0.001), had more combination therapy (38% vs 29%; p = 0.002), and had more frequent prednisone use (55% vs 39%; p < 0.001).

CONCLUSION

Compared to white patients, NAN patients with RA develop disease earlier, are more frequently seropositive, have greater large joint involvement, and greater disease burden, although treatment is more aggressive. These differences are present early and persist throughout the disease course.

摘要

目的

描述前瞻性随访的北美原住民(NAN)类风湿关节炎(RA)患者的表型和结局差异,并与白人 RA 患者进行比较。

方法

采用定制数据库对单中心的患者进行了 20 多年的随访。数据包括诊断、发病年份、种族、改良健康评估问卷(mHAQ)评分、患者和医生总体评分、压痛关节和肿胀关节计数、治疗、血清学和红细胞沉降率(ESR)。提取了所有白人(n=1315)和 NAN(n=481)RA 患者的记录。比较累积治疗数据和临床指标。

结果

与白人患者相比,NAN 患者的疾病持续时间更长(分别为 16±11 年和 14±10 年,p=0.03)。NAN 患者的发病年龄为 34 岁,而白人患者为 43 岁(p<0.001)。NAN 患者类风湿因子(89%比 74%,p<0.001)和抗核抗体(57%比 21%,p<0.001)阳性率更高。尽管压痛关节和肿胀关节的平均计数相似,但 NAN 患者的 Lansbury 评分(加权关节计数;66.5 比 49.7,p<0.001)、mHAQ 评分(1.1 比 0.9,p=0.001)和 ESR(31 比 25mm/h,p<0.012)更高。NAN 患者膝关节(53%比 34%,p<0.001)和肘关节(62%比 48%,p=0.007)受累更频繁。与白人患者相比,NAN 患者一生中接受的疾病修饰抗风湿药物数量更多(3.2±1.9 比 2.2±1.7,p<0.001),联合治疗更多(38%比 29%,p=0.002),更频繁使用泼尼松(55%比 39%,p<0.001)。

结论

与白人患者相比,NAN 患者的 RA 发病更早,更常出现血清阳性,大关节受累更多,疾病负担更大,尽管治疗更积极。这些差异在疾病早期就存在,并贯穿整个病程。

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