Juneblad Kristina, Rantapää-Dahlqvist Solbritt, Alenius Gerd-Marie
From the Department of Public Health and Clinical Medicine, and the Department of Rheumatology, University Hospital, Umeå, Sweden.
K. Juneblad, MD, Department of Public Health and Clinical Medicine/Rheumatology, University Hospital; S. Rantapää-Dahlqvist, MD, PhD, professor, Department of Public Health and Clinical Medicine/Rheumatology, University Hospital; G.M. Alenius, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University Hospital.
J Rheumatol. 2016 Dec;43(12):2155-2161. doi: 10.3899/jrheum.160070. Epub 2016 Oct 1.
Recent studies indicate increased cardiovascular (CV) morbidity and mortality in patients with psoriatic arthritis (PsA), but results are inconsistent. This prompted our investigation of the mortality rate, cause of death, and incidence of acute CV events in patients from northern Sweden with PsA.
Patients with established PsA (464) were included. To calculate standardized mortality ratio (SMR) and standardized incidence ratio (SIR) for CV events, data were extracted from the National Causes of Death Register and the National Inpatient Care Register in Sweden, and compared with the general population. The study period was 1995-2011. To study the effect of inflammatory activity, a composite disease activity index (DAI) was used.
The SMR (95% CI) for overall mortality and diseases of the circulatory system (International Classification of Diseases, 10th edition; I00-I99) was 1.22 (0.89-1.63) and 1.64 (1.02-2.52), respectively. In regression analysis, DAI was significantly associated with death (OR 1.99, 95% CI 1.41-2.80) when adjusted for age and sex (p < 0.001), and remained significant after stratifying patients into the 2 major causes of death: diseases of the circulatory system and malignant neoplasms. Peripheral and axial disease was associated with death (OR 4.02, 95% CI 1.84-8.84, p < 0.001) compared with peripheral disease only. The SIR (95% CI) for a CV event (myocardial infarction or stroke) was 0.597 (0.40-0.86); this association was only significant in men.
Patients with PsA had a small but significant increase in SMR for death due to diseases of the circulatory system compared with the general population. Among patients, death was associated with DAI, as well as axial involvement in combination with peripheral disease, indicating more aggressive disease phenotypes.
近期研究表明银屑病关节炎（PsA）患者的心血管（CV）发病率和死亡率有所增加，但结果并不一致。这促使我们对瑞典北部PsA患者的死亡率、死因及急性CV事件发生率展开调查。
纳入确诊为PsA的患者（464例）。为计算CV事件的标准化死亡率（SMR）和标准化发病率（SIR），从瑞典国家死因登记册和国家住院护理登记册中提取数据，并与普通人群进行比较。研究时间段为1995年至2011年。为研究炎症活动的影响，使用了综合疾病活动指数（DAI）。
全因死亡率和循环系统疾病（国际疾病分类第10版；I00 - I99）的SMR（95%置信区间）分别为1.22（0.89 - 1.63）和1.64（1.02 - 2.52）。在回归分析中，调整年龄和性别后，DAI与死亡显著相关（比值比1.99，95%置信区间1.41 - 2.80）（p < 0.001），且在将患者按两大主要死因（循环系统疾病和恶性肿瘤）分层后仍具有显著性。与仅患有外周疾病相比，外周和中轴疾病与死亡相关（比值比4.02，95%置信区间1.84 - 8.84，p < 0.001）。CV事件（心肌梗死或中风）的SIR（95%置信区间）为0.597（0.40 - 0.86）；这种关联仅在男性中具有显著性。
与普通人群相比，PsA患者因循环系统疾病导致的SMR虽小幅但显著升高。在患者中，死亡与DAI以及中轴受累合并外周疾病相关，表明疾病表型更具侵袭性。
