Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, , Philadelphia, Pennsylvania, USA.
Ann Rheum Dis. 2014 Jan;73(1):149-53. doi: 10.1136/annrheumdis-2012-202424. Epub 2012 Dec 21.
There are conflicting reports in the literature of the mortality risk among patients with psoriatic arthritis (PsA). The objective of this study was to examine the risk of mortality in patients with PsA compared with matched controls, patients with psoriasis and those with rheumatoid arthritis (RA).
A longitudinal cohort study was performed in a large UK medical record database, The Health Improvement Network, among patients with PsA, rheumatoid arthritis (RA) or psoriasis with data from 1994 to 2010. Unexposed controls were matched on practice and start date within the practice for each patient with PsA. Cox proportional hazards models were used to calculate the relative hazards for death.
Patients with PsA (N=8706), RA (N=41 752), psoriasis (N=138 424) and unexposed controls (N=82 258) were identified; 1 442 357 person-years were observed during which 21 825 deaths occurred. Compared with population controls, patients with PsA did not have an increased risk of mortality after adjusting for age and sex (disease-modifying antirheumatic drug (DMARD) users: HR 0.94, 95% CI 0.80 to 1.10; DMARD non-users: HR 1.06, 95% CI 0.94 to 1.19) whereas patients with RA had increased mortality (DMARD users: HR 1.59, 95% CI 1.52 to 1.66; DMARD non-users: HR 1.54, 95% CI 1.47 to 1.60). Patients with psoriasis who had not been prescribed a DMARD had a small increased risk of mortality (HR 1.08, 95% CI 1.04 to 1.12) while those who had been prescribed a DMARD, indicating severe psoriasis, were at increased risk (HR 1.75, 95% CI 1.56 to 1.95).
Patients with RA and psoriasis have increased mortality compared with the general population but patients with PsA do not have a significantly increased risk of mortality.
文献中关于银屑病关节炎（PsA）患者的死亡率存在相互矛盾的报道。本研究的目的是检查与匹配对照、银屑病和类风湿关节炎（RA）患者相比，PsA 患者的死亡风险。
在一个大型英国医疗记录数据库——健康改善网络中，进行了一项纵向队列研究，该研究纳入了 1994 年至 2010 年期间患有 PsA、RA 或银屑病的患者。每个 PsA 患者的未暴露对照均根据实践和开始日期在实践中进行匹配。使用 Cox 比例风险模型计算死亡的相对风险。
共确定了 8706 例 PsA 患者、41752 例 RA 患者、138424 例银屑病患者和 82258 例未暴露对照；共观察到 1442357 人年，发生了 21825 例死亡。调整年龄和性别后，与普通人群对照相比，PsA 患者的死亡率没有增加（疾病修饰抗风湿药物（DMARD）使用者：HR0.94，95%CI0.80 至 1.10；DMARD 非使用者：HR1.06，95%CI0.94 至 1.19），而 RA 患者的死亡率则增加（DMARD 使用者：HR1.59，95%CI1.52 至 1.66；DMARD 非使用者：HR1.54，95%CI1.47 至 1.60）。未使用 DMARD 治疗的银屑病患者死亡率略有增加（HR1.08，95%CI1.04 至 1.12），而使用 DMARD 治疗、表明严重银屑病的患者风险增加（HR1.75，95%CI1.56 至 1.95）。
与普通人群相比，RA 和银屑病患者的死亡率增加，但 PsA 患者的死亡率没有显著增加。
