Pedersen Alma B, Mor Anil, Mehnert Frank, Thomsen Reimar W, Johnsen Søren P, Nørgaard Mette
From the Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.A.B. Pedersen, MD, PhD, associate professor; A. Mor, MD, MPH, research fellow; F. Mehnert, biostatistician, Dipl Math; R.W. Thomsen, MD, PhD, associate professor; S.P. Johnsen, MD, PhD, associate professor; M. Nørgaard, MD, PhD, associate professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital.
J Rheumatol. 2015 Dec;42(12):2247-54. doi: 10.3899/jrheum.141297. Epub 2015 Nov 1.
Over the past decade, the therapeutic approach used to treat patients with rheumatoid arthritis (RA) has considerably changed. It remains unclear whether these changes have been accompanied by decreased disease severity and surgical treatment burden at the population level. Therefore, we investigated time trends in antirheumatic drug consumption, C-reactive protein (CRP) levels, and use of orthopedic surgery among Danish patients with RA.
Using medical databases, we identified all patients with RA living in Northern Denmark during 1996-2012. For each calendar year, we computed the annual rate of antirheumatic drug use (1996-2010), the median CRP value in mg/l (1996-2011), and the proportions of patients who underwent hip replacement and other orthopedic procedures (1996-2012).
Antirheumatic drug consumption per patient increased 5-fold, from 145.0 defined daily doses (DDD) in 1996 to 695.4 DDD in 2010. Median CRP declined from 20.5 mg/l [interquartile range (IQR), 10.0 to 43.5 mg/l] in 1996 to 10.0 mg/l (IQR, 4.2-17.8 mg/l) in 2011. From 1996 to 2012, declining proportions of patients with RA underwent hip replacement (14.9% to 10.1%) and other joint operations (29.1% to 23.4%), while the annual proportion of patients who underwent soft tissue procedures increased from 20.7% to 23.4%.
Antirheumatic drug consumption has substantially increased among patients with RA since 1996, in association with reduced disease activity (i.e., lower CRP levels), fewer joint procedures (including hip replacements), and more soft tissue procedures.
在过去十年中，用于治疗类风湿性关节炎（RA）患者的治疗方法发生了很大变化。目前尚不清楚这些变化是否伴随着人群层面疾病严重程度的降低和手术治疗负担的减轻。因此，我们调查了丹麦RA患者抗风湿药物消费、C反应蛋白（CRP）水平和骨科手术使用情况的时间趋势。
利用医学数据库，我们确定了1996 - 2012年期间居住在丹麦北部的所有RA患者。对于每个日历年，我们计算了抗风湿药物的年使用量（1996 - 2010年）、CRP的中位数（mg/l，1996 - 2011年）以及接受髋关节置换和其他骨科手术的患者比例（1996 - 2012年）。
每位患者的抗风湿药物消费量增加了5倍，从1996年的145.0限定日剂量（DDD）增至2010年的695.4 DDD。CRP中位数从1996年的20.5 mg/l[四分位间距（IQR），10.0至43.5 mg/l]降至2011年的10.0 mg/l（IQR，4.2 - 17.8 mg/l）。从1996年到2012年，接受髋关节置换的RA患者比例下降（从14.9%降至10.1%），接受其他关节手术的患者比例也下降（从29.1%降至23.4%），而接受软组织手术的患者年比例从20.7%增至23.4%。
自1996年以来，RA患者的抗风湿药物消费量大幅增加，同时疾病活动度降低（即CRP水平降低），关节手术（包括髋关节置换）减少，软组织手术增多。
