Abasolo Lydia, Ivorra-Cortes Jose, Leon Leticia, Jover Juan A, Fernandez-Gutierrez Benjamin, Rodriguez-Rodriguez Luis
Rheumatology Department and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Calle Prof. MArtín Lagos s/n, Madrid 28040, Spain.
Rheumatology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Semin Arthritis Rheum. 2016 Apr;45(5):533-8. doi: 10.1016/j.semarthrit.2015.10.016. Epub 2015 Nov 6.
To describe the mortality rate (MR) and standardized MR (SMR) of an incident cohort of rheumatoid arthritis (RA) patients followed up for 20 years, and to analyze the influence on morality risk of different demographic and clinical variables, including radiographic joint damage.
Retrospective longitudinal study that included 2271 RA patients attending the rheumatology outpatient clinic of the Hospital Clínico San Carlos (Madrid, Spain), enrolled from January 1994 to February 2013 and followed up from RA diagnosis to patients׳ death or September 2013. Disability and disease activity were measured as the averaged value of the Heath Assessment Questionnaire and the erythrocyte sedimentation rate, respectively, of the first 2 years after RA diagnosis. Radiographic joint damage of hands and wrists was assessed with the Sharp/van der Heijde score. Indirect SMRs with a 95% of confidence interval (95% CI) were calculated. Cox bivariate and multivariate regression models were performed to assess risk factors for death.
A total of 431 patients died (19%) during the observation time (18,482 person-years), resulting in a MR of 23 subjects per 1000 patient-years [95% CI: 21-26]. SMR was 1.89 (1.72-2.08). In the multivariate analysis, men, older age at diagnosis, the presence of rheumatoid factor, higher number of hospital admissions, greater disease activity, and greater radiographic joint damage were independently associated with greater mortality risk.
RA patients have an excess mortality compared with the general population. Radiological joint damage and early disease activity are independent mortality risk factors. A tighter control at early stages may be necessary to reduce mortality.
描述随访20年的类风湿关节炎（RA）新发队列患者的死亡率（MR）和标准化死亡率（SMR），并分析不同人口统计学和临床变量（包括影像学关节损伤）对死亡风险的影响。
回顾性纵向研究，纳入了2271例在西班牙马德里圣卡洛斯临床医院风湿病门诊就诊的RA患者，这些患者于1994年1月至2013年2月入组，从RA诊断开始随访至患者死亡或2013年9月。残疾和疾病活动度分别以RA诊断后前2年健康评估问卷的平均值和红细胞沉降率来衡量。采用Sharp/van der Heijde评分评估手和腕关节的影像学关节损伤。计算95%置信区间（95%CI）的间接SMR。进行Cox双变量和多变量回归模型以评估死亡的危险因素。
在观察期（18482人年）内共有431例患者死亡（19%），导致MR为每1000患者年23例[95%CI：21-26]。SMR为1.89（1.72-2.08）。在多变量分析中，男性、诊断时年龄较大、类风湿因子阳性、住院次数较多、疾病活动度较高以及影像学关节损伤较重与更高的死亡风险独立相关。
与一般人群相比，RA患者死亡率更高。放射学关节损伤和疾病早期活动度是独立的死亡危险因素。可能需要在早期进行更严格的控制以降低死亡率。
