University of Nebraska Medical Center, Omaha, Nebraska, USA.
J Rheumatol. 2012 Jan;39(1):54-9. doi: 10.3899/jrheum.110491. Epub 2011 Nov 15.
Patients with rheumatoid arthritis (RA) are at increased risk of death. Modern RA therapy has been shown to improve health status, but the relationship of such improvements to mortality risk is unknown. We assessed the relationship between health status and all-cause mortality in patients with RA, using the Health Assessment Questionnaire (HAQ) and the Medical Outcomes Study Short Form-36 questionnaire (SF-36) physical and mental component summary scores (PCS, MCS).
Subjects (n = 10,319) were selected from the National Data Bank for Rheumatic Diseases, a prospective longitudinal observational US study with semiannual assessments of HAQ, PCS, and MCS. Risk of death up to 7 years through 2006 was obtained from the US National Death Index. Relationship of HAQ, PCS, and MCS to mortality was assessed using Cox regression models; prediction accuracy was compared using Harrell's concordance coefficient (C).
Over 64,888 patient-years of followup, there were 1317 deaths. Poorer baseline health status was associated with greater mortality risk. Adjusting for age, sex, and baseline PCS and MCS, declines in PCS and HAQ were associated with higher risk of death. HAQ improvement was associated with reduced mortality risk from 6 months through 3 years; a similar relationship was not observed for PCS or MCS improvement. Controlling for baseline values, change in PCS or HAQ did not improve prediction accuracy.
The HAQ and the SF-36 PCS are similarly and strongly associated with mortality risk in patients with RA. Change in these measures over time does not appear to add to predictive accuracy over baseline levels.
类风湿关节炎（RA）患者的死亡风险增加。现代 RA 治疗已被证明可以改善健康状况，但改善健康状况与死亡风险之间的关系尚不清楚。我们使用健康评估问卷（HAQ）和医疗结果研究 36 项简短形式问卷（SF-36）的身体和心理成分综合评分（PCS、MCS）评估了 RA 患者的健康状况与全因死亡率之间的关系。
从美国国立风湿病数据库（National Data Bank for Rheumatic Diseases）中选择了受试者（n=10319），这是一项前瞻性纵向观察性研究，每半年评估一次 HAQ、PCS 和 MCS。通过美国国家死亡指数获得 2006 年之前长达 7 年的死亡风险。使用 Cox 回归模型评估 HAQ、PCS 和 MCS 与死亡率的关系；使用 Harrell 一致性系数（C）比较预测准确性。
在超过 64888 患者年的随访期间，有 1317 人死亡。基线健康状况越差，死亡风险越高。调整年龄、性别以及基线 PCS 和 MCS 后，PCS 和 HAQ 的下降与死亡风险的增加相关。HAQ 的改善与 6 个月至 3 年内的死亡率降低相关；但 PCS 或 MCS 的改善没有观察到类似的关系。在控制基线值的情况下，PCS 或 HAQ 的变化并没有提高预测准确性。
HAQ 和 SF-36 PCS 在 RA 患者的死亡率风险方面具有相似且强烈的相关性。这些指标随时间的变化似乎并不能增加基线水平以上的预测准确性。
