Grøn Kathrine Lederballe, Ornbjerg Lykke Midtbøll, Hetland Merete Lund, Aslam Fawad, Khan Nasim A, Jacobs Johannes W G, Henrohn Dan, Rasker J J, Kauppi Markku J, Lang Hui-Chu, Mota Licia M H, Aggarwal Amita, Yamanaka Hisahi, Badsha Humeira, Gossec Laure, Cutolo Maurizio, Ferraccioli Gianfranco, Gremese Elisa, Bong Lee Eun, Inanc Nevsun, Direskeneli Haner, Taylor Peter, Huisman Margriet, Alten Rieke, Pohl Christoph, Oyoo Omondi, Stropuviene Sigita, Drosos Alexandrosos A, Kerzberg Eduardo, Ancuta Codorina, Mofti Ayman, Bergman Martin, Detert Jaqueline, Selim Zaraa I, Abda Essam A, Rexhepi Blerta, Sokka Tuulikki
Copenhagen University Hospital at Glostrup, Department of Rheumatology RM, Nordre Ringvej 57, DK-2600 Glostrup, Denmark.
Clin Exp Rheumatol. 2014 Nov-Dec;32(6):869-77. Epub 2014 Oct 20.
The aim is to assess the prevalence of comorbidities and to further analyse to which degree fatigue can be explained by comorbidity burden, disease activity, disability and gross domestic product (GDP) in patients with rheumatoid arthritis (RA).
Nine thousands eight hundred seventy-four patients from 34 countries, 16 with high GDP (>24.000 US dollars [USD] per capita) and 18 low-GDP countries (<24.000 USD) participated in the Quantitative Standard monitoring of Patients with RA (QUEST-RA) study. The prevalence of 31 comorbid conditions, fatigue (0-10 cm visual analogue scale [VAS] [10=worst]), disease activity in 28 joints (DAS28), and physical disability (Health Assessment Questionnaire score [HAQ]) were assessed. Univariate and multivariate linear regression analyses were performed to assess the association between fatigue and comorbidities, disease activity, disability and GDP.
Overall, patients reported a median of 2 comorbid conditions of which hypertension (31.5%), osteoporosis (17.6%), osteoarthritis (15.5%) and hyperlipidaemia (14.2%) were the most prevalent. The majority of comorbidities were more common in high-GDP countries. The median fatigue score was 4.4 (4.8 in low-GDP countries and 3.8 in high-GDP countries, p<0.001). In low-GDP countries 25.4% of the patients had a high level of fatigue (>6.6) compared with 23.0% in high-GDP countries (p<0.001). In univariate analysis, fatigue increased with increasing number of comorbidities, disease activity and disability in both high- and low-GDP countries. In multivariate analysis of all countries, these 3 variables explained 29.4% of the variability, whereas GDP was not significant.
Fatigue is a widespread problem associated with high comorbidity burden, disease activity and disability regardless of GDP.
旨在评估类风湿关节炎（RA）患者合并症的患病率，并进一步分析合并症负担、疾病活动度、残疾程度和国内生产总值（GDP）在多大程度上可解释疲劳现象。
来自34个国家的9874例患者参与了类风湿关节炎患者定量标准监测（QUEST-RA）研究，其中16个为高GDP国家（人均>24000美元），18个为低GDP国家（<24000美元）。评估了31种合并症的患病率、疲劳程度（0-10厘米视觉模拟量表[VAS][10分表示最严重]）、28个关节的疾病活动度（DAS28）和身体残疾程度（健康评估问卷评分[HAQ]）。进行单因素和多因素线性回归分析，以评估疲劳与合并症、疾病活动度、残疾程度和GDP之间的关联。
总体而言，患者报告的合并症中位数为2种，其中高血压（31.5%）、骨质疏松症（17.6%）、骨关节炎（15.5%）和高脂血症（14.2%）最为常见。大多数合并症在高GDP国家更为常见。疲劳评分中位数为4.4（低GDP国家为4.8，高GDP国家为3.8，p<0.001）。在低GDP国家，25.4%的患者疲劳程度较高（>6.6），而高GDP国家为23.0%（p<0.001）。在单因素分析中，高GDP国家和低GDP国家的疲劳程度均随合并症数量、疾病活动度和残疾程度的增加而增加。在所有国家的多因素分析中，这3个变量解释了29.4%的变异性，而GDP不显著。
无论GDP如何，疲劳都是一个与高合并症负担、疾病活动度和残疾程度相关的普遍问题。
