依那西普治疗类风湿关节炎和强直性脊柱炎患者的疲劳状况可独立预测不同的致残维度。
Fatigue independently predicts different work disability dimensions in etanercept-treated rheumatoid arthritis and ankylosing spondylitis patients.
机构信息
Arthritis Research UK Centre for Epidemiology, Faculty of Biology Medicine and Health, the University of Manchester, Manchester, M13 9PT, UK.
Medical Affairs, Pfizer, Sandwich, UK.
出版信息
Arthritis Res Ther. 2018 May 29;20(1):96. doi: 10.1186/s13075-018-1598-8.
BACKGROUND
Work disability remains a significant problem in ankylosing spondylitis (AS) and rheumatoid arthritis (RA), despite biological therapy. This study aimed to test the hypothesis that the prevalent symptom of fatigue longitudinally predicts work disability among RA and AS patients commencing etanercept.
METHODS
Two observational studies, comprising RA and AS etanercept commencers, respectively, were analysed. Both provided data on work disability over 1 year and a comprehensive set of putative predictors, including fatigue. A series of repeated measures models were conducted, including baseline variables, visit (6/12 months), and the interaction between visit and each of the explanatory variables.
RESULTS
A total of 1003 AS and 1747 RA patients were assessed. For AS, fatigue was significantly associated with presenteeism (linear mixed model coefficient 3.75, 95% confidence interval (CI) 2.14 to 5.36) and activity impairment (2.62, 1.26 to 3.98), but not with work productivity loss (1.81, -0.40 to 4.02) or absenteeism (generalised linear mixed model odds ratio (OR) 1.18, 95% CI 0.92 to 1.51). In RA, fatigue was associated with presenteeism (coefficient 3.44, 95% CI 2.17 to 4.70), activity impairment (1.52, 0.79 to 2.26), work productivity loss (4.16, 2.47 to 5.85), and absenteeism (OR 1.23, 95% CI 1.02 to 1.49). The lack of significant interactions between fatigue and visit supported a consistent effect of baseline fatigue over time.
CONCLUSIONS
Among patients beginning etanercept therapy, fatigue has a significant and independent effect on absenteeism, presenteeism, productivity loss, and activity impairment for RA patients and a significant but dimension-selective effect on work disability among AS patients.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT00544557 . Registered on 16 October 2007. ClinicalTrials.gov, NCT00488475 . Registered on 20 June 2006.
背景
尽管使用了生物疗法，致残仍然是强直性脊柱炎（AS）和类风湿关节炎（RA）的一个严重问题。本研究旨在验证这样一个假设，即疲劳这一常见症状可预测开始使用依那西普治疗的 RA 和 AS 患者的致残情况。
方法
分别对两项包含 RA 和 AS 依那西普起始患者的观察性研究进行分析。这两项研究均在 1 年内提供了与致残相关的数据以及一整套潜在预测因素，包括疲劳。进行了一系列重复测量模型，其中包括基线变量、就诊（6/12 个月）以及就诊与每个解释变量之间的交互作用。
结果
共评估了 1003 例 AS 和 1747 例 RA 患者。对于 AS，疲劳与出勤障碍（线性混合模型系数 3.75，95%置信区间（CI）为 2.14 至 5.36）和活动障碍（2.62，1.26 至 3.98）显著相关，但与工作生产力损失（1.81，-0.40 至 4.02）或缺勤（广义线性混合模型比值比（OR）1.18，95%CI 为 0.92 至 1.51）无关。在 RA 中，疲劳与出勤障碍（系数 3.44，95%CI 为 2.17 至 4.70）、活动障碍（1.52，0.79 至 2.26）、工作生产力损失（4.16，2.47 至 5.85）和缺勤（OR 1.23，95%CI 为 1.02 至 1.49）相关。疲劳与就诊之间缺乏显著的交互作用支持了基线疲劳随时间推移的持续影响。
结论
在开始接受依那西普治疗的患者中，疲劳对 RA 患者的缺勤、出勤障碍、生产力损失和活动障碍以及 AS 患者的致残有显著的独立影响。
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