Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK Rheumatology Unit, IRCCS San Matteo Foundation, Pavia, Italy Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
Ann Rheum Dis. 2014 Sep;73(9):1677-82. doi: 10.1136/annrheumdis-2013-203339. Epub 2013 Jun 7.
This study aimed to evaluate whether the early achievement of clinical remission influences overall survival in an inception cohort of patients with inflammatory polyarthritis (IP).
Consecutive early IP patients, recruited to a primary care based inception cohort from 1990 to 1994 and from 2000 to 2004 were eligible for this study. Remission was defined as absence of clinically detectable joint inflammation on a 51-joint count. In sensitivity analyses, less stringent definitions of remission were used, based on 28-joint counts. Remission was assessed at 1, 2 and 3 years after baseline. All patients were flagged with the national death register. Censoring was set at 1 May 2011. The effect of remission on mortality was analysed using the Cox proportional hazard regression model, and presented as HRs and 95% CIs.
A total of 1251 patients were included in the analyses. Having been in remission at least once within the first 3 years of follow-up was associated with a significantly lower risk of death: HR 0.72 (95% CI 0.55 to 0.94). Patients who were in remission 1 year after the baseline assessments and had persistent remission over time had the greatest reduction in mortality risk compared with patients who never achieved remission within the first 3 years of follow-up: HR 0.58 (95% CI 0.37 to 0.91). Remission according to less stringent definitions was associated with progressively lower protective effect.
Early and sustained remission is associated with decreased all-cause mortality in patients with IP. This result supports clinical remission as the target in the management of IP.
本研究旨在评估炎症性多关节炎（IP）患者起始队列中临床缓解的早期获得是否会影响总体生存。
本研究纳入了 1990 年至 1994 年和 2000 年至 2004 年期间从初级保健机构纳入的连续早期 IP 患者。缓解定义为 51 个关节计数无临床可检测到的关节炎症。在敏感性分析中，基于 28 个关节计数，使用更宽松的缓解定义。在基线后 1、2 和 3 年评估缓解。所有患者均在国家死亡登记处登记。截止日期设定为 2011 年 5 月 1 日。使用 Cox 比例风险回归模型分析缓解对死亡率的影响，并以 HR 和 95%CI 表示。
共纳入 1251 例患者进行分析。在随访的前 3 年内至少有一次缓解与死亡风险显著降低相关：HR 0.72（95%CI 0.55 至 0.94）。与在随访的前 3 年内从未达到缓解的患者相比，基线评估后 1 年达到缓解且缓解持续时间较长的患者的死亡风险降低最大：HR 0.58（95%CI 0.37 至 0.91）。更宽松的缓解定义与逐渐降低的保护作用相关。
IP 患者的早期和持续缓解与全因死亡率降低相关。该结果支持将临床缓解作为 IP 管理的目标。
