Espiño-Lorenzo Pilar, Manrique-Arija Sara, Ureña Inmaculada, Jiménez-Núñez Francisco Gabriel, López-Lasanta María, Romero-Barco Carmen María, Belmonte-López María Angeles, Irigoyen María Victoria, Fernández-Nebro Antonio
Rheumatology Service, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
Reumatol Clin. 2013 Jan-Feb;9(1):18-23. doi: 10.1016/j.reuma.2012.05.012. Epub 2012 Aug 28.
To determine whether rheumatoid arthritis (RA) patients who have been prescribed biological agents exhibit a different comorbidity burden than RA patients who take disease-modifying antirheumatic drugs (DMARDs) alone, and to understand the association between comorbidity and other variables, as well as the association between comorbidity and multimorbidity.
This observational case-control study included 114 RA patients treated with biological agents and a control group comprising 163 sex- and age-matched RA patients treated with DMARDs only. Current and previous data regarding the patients' disease activity, comorbidities, and treatments were collected. The data were analysed using bivariate and multivariate regression models.
The patients who were prescribed biological agents exhibited poorer disease control, received more DMARDs and steroids, and underwent more total joint arthroplasties compared with the patients in the control group. However, the risk factors for cardiovascular disease and the comorbidity frequency were similar between cases and controls. The most prevalent comorbidities were hypertension, obesity, and respiratory, thyroid, and upper gastrointestinal disorders. The incidence of cardiovascular disease was low, and only 29% of the patients exhibited multimorbidities. A bivariate association of age, late diagnosis, joint replacements and a high score on the health assessment questionnaire score (HAQ) with comorbidity was observed. There were also correlations between the Charlson index and age, joint reconstructive surgery, disease activity (DAS28), and HAQ score. However, when binary logarithmic regression models were applied, only patient age remained significantly associated with comorbidity and multimorbidity [hazard ratio, 1.08; 95% confidence interval, 1.05-1.12; p<0.0005].
RA patients taking biological drugs have a comorbidity burden equivalent to those treated with DMARDs alone. Age is the main predictive factor of comorbidity in these patients.
确定已开具生物制剂处方的类风湿性关节炎（RA）患者与仅服用改善病情抗风湿药（DMARDs）的RA患者相比，是否具有不同的合并症负担，并了解合并症与其他变量之间的关联，以及合并症与多种疾病共存之间的关联。
这项观察性病例对照研究纳入了114例接受生物制剂治疗的RA患者和一个由163例年龄和性别匹配、仅接受DMARDs治疗的RA患者组成的对照组。收集了有关患者疾病活动、合并症和治疗的当前及既往数据。使用双变量和多变量回归模型对数据进行分析。
与对照组患者相比，开具生物制剂处方的患者疾病控制较差，接受了更多的DMARDs和类固醇治疗，并且接受了更多的全关节置换术。然而，病例组和对照组之间心血管疾病的危险因素和合并症频率相似。最常见的合并症是高血压、肥胖症以及呼吸、甲状腺和上消化道疾病。心血管疾病的发病率较低，只有29%的患者表现出多种疾病共存。观察到年龄、延迟诊断、关节置换以及健康评估问卷评分（HAQ）高分与合并症之间存在双变量关联。Charlson指数与年龄、关节重建手术、疾病活动度（DAS28）和HAQ评分之间也存在相关性。然而，当应用二元对数回归模型时, 只有患者年龄仍与合并症和多种疾病共存显著相关 [风险比，1.08；95%置信区间，1.05-1.12；p<0.0005]。
服用生物药物的RA患者的合并症负担与仅接受DMARDs治疗的患者相当。年龄是这些患者合并症的主要预测因素。
