Arnold Michael B, Bykerk Vivian P, Boire Gilles, Haraoui Boulos P, Hitchon Carol, Thorne Carter, Keystone Edward C, Pope Janet E
Rheumatology (Oxford). 2014 Jun;53(6):1075-86. doi: 10.1093/rheumatology/ket449.
The aim of this study was to determine the impact of age on disease and remission in suspected early RA (ERA).
Data from the Canadian Early Arthritis Cohort (CATCH) were examined at baseline, 6 and 12 months. Patients were divided into three groups based on age. Analysis of variance (ANOVA) and regression models were performed to determine the impact of age on the 28-joint DAS (DAS28) and remission at 12 months.
A total of 1809 patients were initially assessed: 442 (24.4%) young (<42 years), 899 (49.7%) middleaged (542<64 years) and 468 (25.9%) old (564 years); 72.9% female; 63.8% met 2010 ACR/European League Against Rheumatism (EULAR) classification criteria for RA; symptom duration at first visit 186.0 days; DAS28 4.9; HAQ 1.0; 25.3% had baseline erosions. A significant correlation existed between older age and a lower percentage of females, less positive RF and CCP, fewer meeting RA criteria, shorter symptom duration, more erosions at first visit, higher DAS28 and HAQ at baseline and 12 months and fewer DAS28 remission at 12 months (all P<0.003). The age group did not affect the change in DAS28 and HAQ from 0 to 12 months. Co-morbidities increased with age; more DMARDs, including MTX and steroids, and fewer biologics were used in older age. Age and female had a lesser chance of remission in the regression model.
In suspected ERA, older-onset patients start and end their first year worse in terms of DAS28 and HAQ, with fewer meeting RA criteria, less remission, more DMARDs and steroids use but less biologics use. However, there were no differences between age groups in the change in DAS28.
本研究旨在确定年龄对疑似早期类风湿关节炎（ERA）疾病及缓解情况的影响。
对加拿大早期关节炎队列（CATCH）在基线、6个月和12个月时的数据进行分析。患者按年龄分为三组。采用方差分析（ANOVA）和回归模型来确定年龄对28关节疾病活动度评分（DAS28）及12个月时缓解情况的影响。
最初共评估了1809例患者：442例（24.4%）为年轻患者（<42岁），899例（49.7%）为中年患者（42≤64岁），468例（25.9%）为老年患者（≥64岁）；女性占72.9%；63.8%符合2010年美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）类风湿关节炎分类标准；首次就诊时症状持续时间为186.0天；DAS28为4.9；健康评估问卷（HAQ）为1.0；25.3%患者基线时有骨侵蚀。年龄较大与女性比例较低、类风湿因子（RF）和环瓜氨酸肽（CCP）阳性率较低、符合类风湿关节炎标准的患者较少、症状持续时间较短、首次就诊时骨侵蚀较多、基线及12个月时DAS28和HAQ较高以及12个月时DAS28缓解患者较少均存在显著相关性（所有P<0.003）。年龄组对0至12个月期间DAS28和HAQ的变化无影响。合并症随年龄增加；老年患者使用更多的改善病情抗风湿药（DMARDs），包括甲氨蝶呤（MTX）和类固醇，而使用生物制剂较少。在回归模型中，年龄和女性缓解的可能性较小。
在疑似ERA患者中，起病较晚的老年患者在DAS28和HAQ方面起始及第一年末情况较差，符合类风湿关节炎标准的患者较少，缓解较少，使用更多的DMARDs和类固醇，但使用生物制剂较少。然而，各年龄组之间DAS28的变化无差异。
