Emamifar Amir, Jensen Hansen Inger Marie
Department of Medicine, Odense University Hospital, Svendborg Hospital, Svendborg Faculty of Health Sciences, University of Southern Denmark, Odense Section of Rheumatology, Department of Medicine, Odense University Hospital, Svendborg Hospital, Svendborg Danbio, Copenhagen, Denmark.
Medicine (Baltimore). 2018 May;97(21):e10865. doi: 10.1097/MD.0000000000010865.
To investigate the impact of comorbid diseases on rheumatoid arthritis (RA) outcome.All patients diagnosed with RA since 2006, who were registered in our local Danbio registry, were included in this cohort study. Patients' demographics, serology results, and Disease Activity Score in 28 joints-C-reactive protein (DAS28-CRP) at the time of diagnosis and after 4 months of treatment initiation were collected. Patients' electronic hospital records were evaluated for a positive history of thyroid diseases, diabetes mellitus, primary hyperparathyroidism, vitamin B12 deficiency, and the presence of other diagnosed autoimmune diseases.1035 RA patients were included. The observed prevalence of thyroid diseases was 11.8%, DM 10.4%, primary hyperparathyroidism 2.8%, vitamin B12 deficiency 5.8%, and other diagnosed autoimmune diseases 1.6%. There were significant associations between presence of thyroid diseases and female gender (P < .001); DM and greater age (P < .001); primary hyperparathyroidism and longer disease duration (P = .002); other diagnosed autoimmune diseases and antinuclear antibody positivity (P < .001). RA patients with thyroid diseases (P = .001) and other comorbid autoimmune diseases (P < .001) had significantly poorer initial response to the RA treatment compared to patients with isolated RA.Univariate analyses revealed that age, the presence of thyroid diseases, the presence of other diagnosed autoimmune diseases and DAS28-CRP at the time of diagnosis were significantly associated with ΔDAS28-CRP. Additionally, multivariate analysis demonstrated that ΔDAS28-CRP deterioration was significantly correlated to the presence of thyroid diseases (unstandardized regression coefficient (standard error); -0.188 (0.088), P = .030) and the presence of other diagnosed autoimmune diseases (-0.537 (0.208), P = .010).RA patients are at increased risk of specific comorbidities with possible impact on the treatment outcome. To improve this situation, periodic assessment of comorbidities should be considered.
为研究合并症对类风湿关节炎（RA）预后的影响。所有自2006年起确诊为RA并登记在本地Danbio登记处的患者均纳入本队列研究。收集患者的人口统计学资料、血清学结果以及诊断时和开始治疗4个月后的28个关节疾病活动评分- C反应蛋白（DAS28-CRP）。评估患者的电子医院记录，以了解甲状腺疾病、糖尿病、原发性甲状旁腺功能亢进、维生素B12缺乏的阳性病史以及其他已确诊自身免疫性疾病的情况。纳入了1035例RA患者。观察到甲状腺疾病的患病率为11.8%，糖尿病为10.4%，原发性甲状旁腺功能亢进为2.8%，维生素B12缺乏为5.8%，其他已确诊自身免疫性疾病为1.6%。甲状腺疾病与女性性别之间存在显著关联（P<0.001）；糖尿病与年龄较大之间存在显著关联（P<0.001）；原发性甲状旁腺功能亢进与病程较长之间存在显著关联（P = 0.002）；其他已确诊自身免疫性疾病与抗核抗体阳性之间存在显著关联（P<0.001）。与单纯RA患者相比，患有甲状腺疾病（P = 0.001）和其他合并自身免疫性疾病（P<0.001）的RA患者对RA治疗的初始反应明显较差。单因素分析显示，年龄、甲状腺疾病的存在、其他已确诊自身免疫性疾病的存在以及诊断时的DAS28-CRP与ΔDAS28-CRP显著相关。此外，多因素分析表明，ΔDAS28-CRP恶化与甲状腺疾病的存在（非标准化回归系数（标准误）；-0.188（0.088），P = 0.030）和其他已确诊自身免疫性疾病的存在（-0.537（0.208），P = 0.010）显著相关。RA患者发生特定合并症的风险增加，可能会影响治疗结果。为改善这种情况，应考虑定期评估合并症。
