抗风湿药物对类风湿关节炎患者痴呆症的保护作用。
Protective effect of antirheumatic drugs on dementia in rheumatoid arthritis patients.
作者信息
Judge Andy, Garriga Cesar, Arden Nigel K, Lovestone Simon, Prieto-Alhambra Dani, Cooper Cyrus, Edwards Christopher J
机构信息
Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
出版信息
Alzheimers Dement (N Y). 2017 Nov 9;3(4):612-621. doi: 10.1016/j.trci.2017.10.002. eCollection 2017 Nov.
INTRODUCTION
Rheumatoid arthritis is a systemic inflammatory disease, and classical disease-modifying antirheumatic drugs (cDMARDs) have proven efficacy. It is unknown what impact cDMARDs might have on dementia as an outcome.
METHODS
Incident diagnoses of rheumatoid arthritis in persons over 18 years from 1995 to 2011 were identified from the UK Clinical Practice Research Datalink. There were 3876 cDMARD users and were propensity score matched to 1938 nonusers, on a wide range of confounders. Impact on dementia was assessed using survival models.
RESULTS
cDMARD users were at reduced risk of dementia (hazard ratio: 0.60; 95% confidence interval: 0.42-0.85). The effect was strongest in methotrexate users (hazard ratio: 0.52; 95% confidence interval; 0.34-0.82).
DISCUSSION
The strong effect of cDMARD use on halving of dementia risk requires replication in a trial and may provide an important therapeutic pharmacological treatment.
引言
类风湿性关节炎是一种全身性炎症性疾病，经典的改善病情抗风湿药物（cDMARDs）已被证明具有疗效。目前尚不清楚cDMARDs作为一种结果对痴呆症可能有何种影响。
方法
从英国临床实践研究数据链中确定1995年至2011年18岁以上人群中类风湿性关节炎的新发诊断病例。有3876名cDMARD使用者，并根据广泛的混杂因素与1938名非使用者进行倾向评分匹配。使用生存模型评估对痴呆症的影响。
结果
cDMARD使用者患痴呆症的风险降低（风险比：0.60；95%置信区间：0.42 - 0.85）。在使用甲氨蝶呤的使用者中效果最强（风险比：0.52；95%置信区间：0.34 - 0.82）。
讨论
使用cDMARDs对痴呆风险减半的显著效果需要在试验中重复验证，并且可能提供一种重要的治疗性药物治疗方法。
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