Ingegnoli Francesca, Ughi Nicola, Crotti Chiara, Mosca Marta, Tani Chiara
Division of Rheumatology, ASST Pini, Dept. of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy.
Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Swiss Med Wkly. 2017 Sep 30;147:w14506. doi: 10.4414/smw.2017.14506. eCollection 2017.
Published studies lack clear indicators of risk and predictors of transition from Raynaud's phenomenon (Rp) to connective tissue diseases (CTDs). Therefore, we aimed to study the outcomes, rates and predictors of transition to CTDs in patients with Rp.
A sensitive search was developed in Medline and Embase. Observational studies reporting incidence and risk factors of transition from Rp to a CTD were analysed by two independent reviewers. The main outcome was the rate of transition to a CTD; the secondary outcome was the evaluation of predictors.
Of 856 articles captured, 7 selected studies met the inclusion criteria. A total of 4051 patients with primary Rp (pRp) and 1220 transitions to overt CTDs were recorded. The mean incidence rate of transition from pRp to a CTD was 2.65/100 person-years (standard error [SE] 1.2, 95% confidence interval [CI] 0.44-5.73). A total of 657 patients with suspected secondary Rp (ssRp) had antinuclear antibodies (ANAs) and/or capillary abnormalities; 188 transitions to CTDs were recorded, the mean incidence rate of transition from ssRp to CTD was 11.01/100 person-years (SE 4.0, 95% CI 0.11-22.12), and 135 transitions to systemic sclerosis (SSc), giving a mean incidence rate of transition from ssRp to SSc of 5.7/100 person-years (SE 2.19, 95% CI 1.02-13.19). With respect to patients with pRp, having ANAs without capillary abnormalities was associated with a risk for developing a CTD (pooled relative risks [RR] 7.63, 95% CI 2.87-20.29), whereas capillary abnormalities without ANAs resulted in a weaker risk of CTD transition (RR 5.53, 95% CI 1.45-21.06). The coexistence of ANAs and abnormal capillaroscopy significantly increased the risk of transition to CTD (RR 16.96, 95% CI 6.61-43.55).
A low incidence rate of transition from pRp to overt CTD was found. In spite of a possible study selection bias, ssRp appears to have a strong risk of transition to a CTD when there is concomitant presence of ANAs and abnormal capillaroscopy.
已发表的研究缺乏明确的风险指标以及从雷诺现象（Rp）转变为结缔组织病（CTD）的预测因素。因此，我们旨在研究Rp患者转变为CTD的结局、发生率及预测因素。
在Medline和Embase中进行了全面检索。由两名独立的审阅者分析报告从Rp转变为CTD的发生率及风险因素的观察性研究。主要结局是转变为CTD的发生率；次要结局是对预测因素的评估。
在检索到的856篇文章中，7项入选研究符合纳入标准。共记录了4051例原发性Rp（pRp）患者以及1220例转变为显性CTD的病例。从pRp转变为CTD的平均发生率为2.65/100人年（标准误[SE]1.2，95%置信区间[CI]0.44 - 5.73）。共有657例疑似继发性Rp（ssRp）患者存在抗核抗体（ANA）和/或毛细血管异常；记录到188例转变为CTD的病例，从ssRp转变为CTD的平均发生率为11.01/100人年（SE 4.0，95%CI 0.11 - 22.12），135例转变为系统性硬化症（SSc），从ssRp转变为SSc的平均发生率为5.7/100人年（SE 2.19，95%CI 1.02 - 13.19）。对于pRp患者，存在ANA但无毛细血管异常与发生CTD的风险相关（合并相对风险[RR]7.63，95%CI 2.87 - 20.29），而无ANA但有毛细血管异常导致CTD转变的风险较低（RR 5.53，95%CI 1.45 - 21.06）。ANA与异常毛细血管镜检查同时存在显著增加了转变为CTD的风险（RR 16.96，95%CI 6.61 - 43.55）。
发现从pRp转变为显性CTD的发生率较低。尽管可能存在研究选择偏倚，但当同时存在ANA和异常毛细血管镜检查时，ssRp似乎有较高的转变为CTD的风险。
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