早期强化治疗对老年类风湿关节炎患者的长期影响：两项基于人群的队列研究关于关节置换手术时间的比较
The Longterm Effect of Early Intensive Treatment of Seniors with Rheumatoid Arthritis: A Comparison of 2 Population-based Cohort Studies on Time to Joint Replacement Surgery.
作者信息
Widdifield Jessica, Moura Cristiano S, Wang Yishu, Abrahamowicz Michal, Paterson J Michael, Huang Anjie, Beauchamp Marie-Eve, Boire Gilles, Fortin Paul R, Bessette Louis, Bombardier Claire, Hanly John G, Feldman Debbie, Bernatsky Sasha
机构信息
From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
出版信息
J Rheumatol. 2016 May;43(5):861-8. doi: 10.3899/jrheum.151156. Epub 2016 Feb 15.
OBJECTIVE
Disease-modifying antirheumatic drugs (DMARD) have the greatest effect when initiated early. We evaluated the influence of early exposure to DMARD on time to joint replacement surgery among patients with incident rheumatoid arthritis (RA).
METHOD
Using a common protocol, we undertook 2 independent population-based cohort studies of patients with incident RA aged 66 years or older in Ontario (ON) and Quebec (QC) covering the period 2000-2013. We used Cox proportional hazards regression with time-dependent variables measuring duration of drug use in the first year, separately for methotrexate (MTX) and other DMARD, adjusting for baseline demographics, clinical factors, and other potentially confounding drug exposures. Our outcome measure was any joint replacement derived from standardized procedure codes. Adjusted HR and 95% CI were estimated.
RESULTS
Among 20,918 ON and 6754 QC patients with RA followed for a median of 4.5 years, 2201 and 494 patients underwent joint replacement surgery for crude event rates of 2.0 and 1.4 per 100 person-years, respectively. Greater cumulative exposure to MTX (HR 0.97, 95% CI 0.95-0.98) and other DMARD (HR 0.98, 95% CI 0.97-0.99) in the first year after diagnosis was associated with longer times to joint replacement in ON, corresponding to a 2-3% decrease in the hazard of surgery with each additional month of early use. Similar results were observed in QC.
CONCLUSION
Greater duration of exposure to DMARD soon after RA diagnosis was associated with delays to joint replacement surgery in both provinces. Early intensive treatment of RA may ultimately reduce demand for joint replacement surgery.
目的
改善病情抗风湿药（DMARD）在早期使用时效果最佳。我们评估了早期接触DMARD对新发类风湿关节炎（RA）患者进行关节置换手术时间的影响。
方法
我们采用通用方案，对安大略省（ON）和魁北克省（QC）年龄在66岁及以上的新发RA患者进行了2项独立的基于人群的队列研究，研究时间为2000年至2013年。我们使用Cox比例风险回归模型，采用随时间变化的变量来衡量第一年的药物使用时长，分别针对甲氨蝶呤（MTX）和其他DMARD进行分析，并对基线人口统计学、临床因素及其他可能产生混淆的药物暴露情况进行校正。我们的结局指标是根据标准化程序编码得出的任何关节置换手术。估算校正后的风险比（HR）和95%置信区间（CI）。
结果
在安大略省的20918例和魁北克省的6754例RA患者中，中位随访时间为4.5年，分别有2201例和494例患者接受了关节置换手术，粗事件发生率分别为每100人年2.0例和1.4例。在安大略省，诊断后第一年MTX（HR 0.97，95% CI 0.95 - 0.98）和其他DMARD（HR 0.98，95% CI 0.97 - 0.99）的累积暴露量越高，与关节置换手术时间越长相关，即早期使用每增加一个月，手术风险降低2 - 3%。在魁北克省也观察到了类似结果。
结论
在这两个省份，RA诊断后不久DMARD暴露时间越长，与关节置换手术延迟相关。RA的早期强化治疗可能最终会减少关节置换手术的需求。
Zotero 插件