Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA.
J Rheumatol. 2011 Jun;38(6):983-9. doi: 10.3899/jrheum.101133. Epub 2011 Apr 1.
To assess incidence and mortality effects of extraarticular rheumatoid arthritis (ExRA) in patients with incident RA in 1995-2007 compared to 1985-1994, in Olmsted County, Minnesota, USA.
Data on incident ExRA were abstracted from medical records of patients with RA - Olmsted County residents who first met the 1987 American College of Rheumatology criteria for RA between January 1, 1995, and December 31, 2007. Patients were followed until death, migration from Olmsted County, or December 31, 2008. ExRA were classified using the predefined criteria and compared to the corresponding 1985-1994 inception RA cohort (n = 147).
The 1995-2007 cohort included 463 patients with RA followed for a mean of 6.3 years; mean age was 55.6 years, 69% were women, 67% were positive for rheumatoid factor (RF). The 10-year cumulative incidence of any ExRA (50.1%) and severe ExRA (6.7%) in the 1995-2007 cohort was similar to the 1985-1994 cohort (46.2% and 9.7%, respectively). The 10-year cumulative incidence of vasculitis, but not other features of ExRA, was significantly lower in the 1995-2007 cohort (0.6%) compared to the 1985-1994 cohort (3.6%). RF positivity, erosions/destructive changes, and use of methotrexate, other disease-modifying antirheumatic drugs and systemic corticosteroids were significantly associated with ExRA in the 1995-2007 cohort. ExRA was associated with mortality risk (HR 2.1, 95% CI 1.2, 3.7) in the 1995-2007 cohort. The decrease in mortality following ExRA in the 1995-2007 cohort versus the 1985-1994 cohort did not reach statistical significance (HR 0.6, 95% CI 0.3, 1.2, p = 0.16).
ExRA remains a common complication associated with increased mortality in RA. The occurrence of vasculitis appears to be decreasing in recent years.
评估美国明尼苏达州奥姆斯特德县 1995-2007 年与 1985-1994 年新确诊类风湿关节炎（RA）患者的关节外类风湿关节炎（ExRA）发病率和死亡率。
从符合 1987 年美国风湿病学会 RA 标准的奥姆斯特德县 RA 居民患者的病历中提取 ExRA 数据，这些患者于 1995 年 1 月 1 日至 2007 年 12 月 31 日首次确诊为 RA。患者随访至死亡、迁出奥姆斯特德县或 2008 年 12 月 31 日。根据预定义标准对 ExRA 进行分类，并与相应的 1985-1994 年发病 RA 队列（n=147）进行比较。
1995-2007 年队列包括 463 名 RA 患者，平均随访 6.3 年；平均年龄为 55.6 岁，69%为女性，67%为类风湿因子（RF）阳性。1995-2007 年队列中任何 ExRA（50.1%）和严重 ExRA（6.7%）的 10 年累积发生率与 1985-1994 年队列相似（分别为 46.2%和 9.7%）。与 1985-1994 年队列相比（3.6%），1995-2007 年队列中血管炎的 10 年累积发生率（0.6%）显著降低，但其他 ExRA 特征并无差异。RF 阳性、侵蚀/破坏性改变以及甲氨蝶呤、其他疾病修饰抗风湿药物和全身皮质类固醇的使用在 1995-2007 年队列中与 ExRA 显著相关。ExRA 与 1995-2007 年队列的死亡风险相关（HR 2.1，95%CI 1.2，3.7）。与 1985-1994 年队列相比，1995-2007 年队列中 ExRA 后死亡率下降无统计学意义（HR 0.6，95%CI 0.3，1.2，p=0.16）。
ExRA 仍然是 RA 患者死亡风险增加的常见并发症。近年来，血管炎的发生似乎有所减少。
