Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Rheumatology Department, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK.
Ann Rheum Dis. 2018 Jun;77(6):848-854. doi: 10.1136/annrheumdis-2017-212426. Epub 2018 Feb 23.
To compare the 10-year outcome (disease activity, disability, mortality) of two cohorts of patients with inflammatory polyarthritis (IP) recruited 10 years apart.
Patients with IP were recruited to the Norfolk Arthritis Register from 1990 to 1994 (cohort 1 (C1)) and from 2000 to 2004 (cohort 2 (C2)). Demographic and clinical data were collected at baseline and at years 1, 2, 3, 5, 7 and 10. Longitudinal disease activity (swollen/tender 51 joint counts (SJC51/TJC51)) and disability (Health Assessment Questionnaire (HAQ)) were compared between the cohorts using population-average negative binomial regression and generalised estimating equation analysis, respectively. Risk of 10-year mortality was compared between cohorts using Cox models. Risk of cardiovascular disease (CVD) mortality was compared between cohorts using competing risks analysis. Mortality rate ratios (MRR), adjusted for changes in mortality risk of the general population, were calculated using Poisson regression.
In total 1653 patients were recruited (C1=1022, C2=631). Patients in C2 had 17% lower SJC51 than C1 over 10 years (95% CI -23% to -10%), whereas TJC51 and HAQ were comparable. C2 patients had reduced risk of all-cause and CVD mortality compared with C1 (all-cause: HR 0.72, 95% CI 0.56 to 0.95; CVD: subhazard ratio 0.58, 95% CI 0.37 to 0.93). After accounting for changes in mortality risk in the general population, the difference in mortality was non-significant (all-cause: MRR 0.78, 95% CI 0.56 to 1.10; CVD: MRR 0.77, 95% CI 0.48 to 1.24).
Disease activity significantly improved in the new millennium, whereas disability and mortality were unchanged.
比较两组炎症性多关节炎（IP）患者在相隔 10 年招募的 10 年结局（疾病活动度、残疾、死亡率）。
1990 年至 1994 年（队列 1（C1））和 2000 年至 2004 年（队列 2（C2））期间，从诺福克关节炎登记处招募 IP 患者。在基线和第 1、2、3、5、7 和 10 年收集人口统计学和临床数据。使用人群平均负二项回归和广义估计方程分析分别比较两组之间的纵向疾病活动度（肿胀/压痛 51 关节计数（SJC51/TJC51））和残疾（健康评估问卷（HAQ））。使用 Cox 模型比较两组之间 10 年死亡率的风险。使用竞争风险分析比较两组之间心血管疾病（CVD）死亡率的风险。使用泊松回归计算校正一般人群死亡率风险变化后的死亡率率比（MRR）。
共招募了 1653 名患者（C1=1022，C2=631）。C2 患者在 10 年内的 SJC51 比 C1 低 17%（95%CI-23%至-10%），而 TJC51 和 HAQ 相似。与 C1 相比，C2 患者的全因和 CVD 死亡率风险降低（全因：HR0.72，95%CI0.56 至 0.95；CVD：亚危险比 0.58，95%CI0.37 至 0.93）。在考虑到一般人群死亡率风险的变化后，死亡率差异无统计学意义（全因：MRR0.78，95%CI0.56 至 1.10；CVD：MRR0.77，95%CI0.48 至 1.24）。
新世纪疾病活动度显著改善，而残疾和死亡率保持不变。
