Silman A J
Arthritis and Rheumatism Council Epidemiology Research Unit, Manchester University Medical School, UK.
Scand J Rheumatol Suppl. 1989;79:25-30. doi: 10.3109/03009748909092609.
There are considerable research and health service benefits in understanding current trends in a disease as common and as severe as rheumatoid arthritis. Unfortunately in the absence of both a high and constant case fatality rate and a population based morbidity registration system, there is no direct means of assessing changes in incidence in contrast, for example, to the situation with cancer. All the available data are inadequate and subject to considerable bias. It is of note however that all the available data are relatively consistent in pointing to a recent reduction in incidence over the last two decades coupled with a decrease in case severity. The immediate problem remains therefore to set up a true population based recording system which will permit the identification of trends both of incidence and severity. It should not be necessary for this to be established nationwide and a study area within a country could be chosen providing its population was representative and of sufficient size. For the latter a minimum seize of 500,000 persons would be needed.
了解类风湿关节炎这种常见且严重疾病的当前趋势，在研究和医疗服务方面具有相当大的益处。遗憾的是，由于既没有高且持续的病死率，也没有基于人群的发病率登记系统，与癌症的情况相比，没有直接评估发病率变化的方法。所有现有数据都不充分且存在相当大的偏差。然而值得注意的是，所有现有数据相对一致地表明，在过去二十年中发病率近期有所下降，同时病例严重程度也有所降低。因此，当务之急仍然是建立一个真正基于人群的记录系统，以便能够识别发病率和严重程度的趋势。不一定要在全国范围内建立，在一个国家内可以选择一个研究区域，前提是其人口具有代表性且规模足够大。对于后者，至少需要50万人的规模。
