报告患有类风湿关节炎的妇女健康倡议中绝经后妇女的死亡率决定因素。
Determinants of mortality among postmenopausal women in the women's health initiative who report rheumatoid arthritis.
机构信息
University of Pittsburgh, Pittsburgh, Pennsylvania.
出版信息
Arthritis Rheumatol. 2014 Mar;66(3):497-507. doi: 10.1002/art.38268.
OBJECTIVE
Rheumatoid arthritis (RA) patients have an increased risk of cardiovascular disease (CVD) and mortality. We measured anti-cyclic citrullinated peptide (anti-CCP) antibody levels and determined use of disease-modifying antirheumatic drugs (DMARDs) among women in the Women's Health Initiative (WHI). Using these data, we undertook this study to assess total mortality over 10 years of followup among white, black, or Hispanic women with self-reported RA in the WHI.
METHODS
Using stored baseline serum, we measured anti-CCP, rheumatoid factor (RF), and antinuclear antibodies (ANAs) in 9,988 women who reported having RA. Based on a previous chart review study, probable RA was defined as either self-reported RA and anti-CCP positivity, or anti-CCP negativity and DMARD use. Cox proportional hazards regression was used to model the relationship of self-reported RA, DMARD exposure, and anti-CCP positivity to total mortality, using followup data through April 2009.
RESULTS
At baseline, the mean age was 62.8 years; 24.5% of subjects were black and 10% were Hispanic. Prevalence of anti-CCP positivity was 8.1% (n = 812), and 217 women were anti-CCP negative but had reported use of DMARDs; therefore, 1,029 women (of 9,988) were classified as having probable RA, and 8,958 were classified as unlikely to have RA (with data on DMARD use missing for 1 subject). Age-adjusted mortality rates were ∼2-fold higher for anti-CCP-positive women, with 20.2 deaths per 1,000 person-years, as compared to 11.4 deaths per 1,000 person-years among anti-CCP-negative women with self-reported RA who never used DMARDs. Among women who did not report any arthritis at baseline, we found 8.3 deaths per 1,000 person-years. The increased risk among anti-CCP-positive women with RA was not explained by age, RF positivity, ANA positivity, or DMARD use.
CONCLUSION
Anti-CCP-positive RA was associated with substantial excess mortality among postmenopausal women in the WHI. This result was not explained by the risk factors we measured.
目的
类风湿关节炎（RA）患者发生心血管疾病（CVD）和死亡的风险增加。我们在妇女健康倡议（WHI）中测量了抗环瓜氨酸肽（抗-CCP）抗体水平，并确定了疾病修饰抗风湿药物（DMARDs）的使用情况。利用这些数据，我们进行了这项研究，以评估 WHI 中自我报告的 RA 白人、黑人和西班牙裔女性在 10 年随访期间的总死亡率。
方法
使用储存的基线血清，我们在 9988 名报告患有 RA 的女性中测量了抗 CCP、类风湿因子（RF）和抗核抗体（ANA）。基于之前的图表审查研究，将可能的 RA 定义为自我报告的 RA 和抗 CCP 阳性，或抗 CCP 阴性和 DMARD 使用。使用 Cox 比例风险回归模型来模拟自我报告的 RA、DMARD 暴露和抗 CCP 阳性与总死亡率之间的关系，使用截至 2009 年 4 月的随访数据。
结果
在基线时，平均年龄为 62.8 岁；24.5%的受试者为黑人，10%为西班牙裔。抗 CCP 阳性的患病率为 8.1%（n=812），有 217 名女性抗 CCP 阴性但报告使用 DMARDs；因此，9988 名女性中有 1029 名（n=1029）被归类为患有可能的 RA，8958 名被归类为不太可能患有 RA（其中 1 名女性 DMARD 使用数据缺失）。抗 CCP 阳性女性的年龄调整死亡率约为 2 倍，每 1000 人年有 20.2 例死亡，而抗 CCP 阴性且从未使用过 DMARDs 的自我报告 RA 女性为每 1000 人年 11.4 例死亡。在基线时未报告任何关节炎的女性中，我们发现每 1000 人年有 8.3 例死亡。RA 患者抗 CCP 阳性的风险增加不能用年龄、RF 阳性、ANA 阳性或 DMARD 使用来解释。
结论
在 WHI 中，抗 CCP 阳性 RA 与绝经后妇女的大量超额死亡有关。这一结果不能用我们测量的危险因素来解释。
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