Heinimann Katja, von Kempis Johannes, Sauter Rafael, Schiff Michael, Sokka-Isler Tuulikki, Schulze-Koops Hendrik, Müller Rüdiger
Division of Rheumatology, Immunology and Rehabilitation, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
Clinical Trials Unit, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
J Clin Med. 2018 Mar 13;7(3):57. doi: 10.3390/jcm7030057.
There is little information on the relation between disease duration, disability and radiographic outcome since the introduction of biologics into the therapy of rheumatoid arthritis (RA). No long -term cohort studies have been conducted on this subject so far. To analyse radiographic damage, disability, and disease activity in RA-patients dependent on disease duration in the Swiss national RA cohort (SCQM).
The primary outcome was the association between the radiographic destruction, assessed by Ratingen scores, and disease duration. All patients with at least one clinical visit were analysed with polynomial and multiple negative binomial models.
The disease duration in the 8678 patients with available radiographs analysed ranged between less than 1 and more than 65 years (median 8.3). Disease duration and radiographic destruction were significantly associated with an average increase of Ratingen scores by 8.3% per year. Apart from disease duration, positive rheumatoid factor was the strongest predictor for radiographic destruction. While DAS28-scores remained stable in patients with a disease duration of more than 5 years (median DAS28 2.8), HAQ-DI scores increased continuously by 0.018 for each additional year.
In this RA cohort, patients show a continuous increase of articular destruction and physical disability in parallel with disease duration. Even when nowadays a satisfactory control of disease activity can be achieved in most patients, RA remains a destructive disease leading to joint destruction and physical disability in many patients.
自从生物制剂被引入类风湿关节炎(RA)治疗以来,关于疾病持续时间、残疾与放射学结果之间关系的信息很少。到目前为止,尚未针对该主题进行长期队列研究。在瑞士全国RA队列(SCQM)中,分析依赖于疾病持续时间的RA患者的放射学损伤、残疾和疾病活动情况。
主要结局是通过雷根斯堡评分评估的放射学破坏与疾病持续时间之间的关联。所有至少有一次临床就诊的患者均采用多项式和多重负二项式模型进行分析。
在分析的8678例有可用X光片的患者中,疾病持续时间在不到1年至超过65年之间(中位数8.3年)。疾病持续时间与放射学破坏显著相关,雷根斯堡评分平均每年增加8.3%。除疾病持续时间外,类风湿因子阳性是放射学破坏的最强预测因素。在疾病持续时间超过5年的患者中(DAS28中位数为2.8),DAS28评分保持稳定,而HAQ-DI评分每增加一年持续增加0.018。
在这个RA队列中,患者的关节破坏和身体残疾随着疾病持续时间的延长而持续增加。即使如今大多数患者能够实现对疾病活动的满意控制,但RA仍然是一种破坏性疾病,会导致许多患者出现关节破坏和身体残疾。