Fragoulis George E, Paterson Caron, Gilmour Ashley, Derakhshan Mohammad H, McInnes Iain B, Porter Duncan, Siebert Stefan
Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
RMD Open. 2018 Oct 8;4(2):e000739. doi: 10.1136/rmdopen-2018-000739. eCollection 2018.
To determine the frequency, severity and natural history of neutropaenia in early rheumatoid arthritis (RA), explore its associations with clinical features and assess its impact on clinical management.
The Scottish Early Rheumatoid Arthritis inception cohort prospectively recruited patients with newly diagnosed RA and followed them up every 6 months. Patients with RA who developed at least one episode of neutropaenia (grade 1: <2.0×10^9/L; grade 2: <1.5×10^9/L; grade 3: <1.0×10^9/L; grade 4: <0.5×10^9/L) were compared with those who did not. Comparisons were also made between patients who experienced one or more episodes of neutropaenia and between patients with different neutropaenia grades.
77 neutropaenia episodes were recorded in 58 of 771 (7.5%) patients with RA, who were followed up for a median (range) of 18 (6-48) months. Neutropaenia occurred at a median (range) of 12 (0-120) months after RA diagnosis. The majority had mild neutropaenia (grade 1: n=42; grade 2: n=14; grade 3: n=1; grade 4: n=1). Neutropaenia was transient (single episode) in the majority (44; 75.8%) of cases but led to treatment discontinuation in 14 (24.1%) patients. Patients who developed neutropaenia were more likely to be female (p=0.01) and non-smokers (p=0.007) and had lower baseline neutrophil levels (p<0.0001). Binomial regression analysis confirmed the latter (p<0.0001, B: -0.491) as neutropaenia predictor. The rate of infections did not differ between patients who developed neutropaenia and those who did not (p=0.878).
Neutropaenia was a common finding in this cohort. It was usually mild, transient and not associated with increased infection rates. Neutropaenia occurrence was associated with non-smoking, female gender and lower baseline neutrophil levels.
确定早期类风湿关节炎（RA）患者中性粒细胞减少症的发生率、严重程度及自然病程，探讨其与临床特征的关联，并评估其对临床管理的影响。
苏格兰早期类风湿关节炎起始队列前瞻性招募新诊断的RA患者，并每6个月对其进行随访。将发生至少一次中性粒细胞减少症（1级：<2.0×10^9/L；2级：<1.5×10^9/L；3级：<1.0×10^9/L；4级：<0.5×10^9/L）的RA患者与未发生的患者进行比较。还对经历过一次或多次中性粒细胞减少症的患者之间以及不同中性粒细胞减少症分级的患者之间进行了比较。
771例RA患者中有58例（7.5%）记录到77次中性粒细胞减少症发作，随访时间中位数（范围）为18（6 - 48）个月。中性粒细胞减少症在RA诊断后中位数（范围）12（0 - 120）个月出现。大多数为轻度中性粒细胞减少症（1级：n = 42；2级：n = 14；3级：n = 1；4级：n = 1）。大多数病例（44例；75.8%）的中性粒细胞减少症是短暂性的（单次发作），但导致14例（24.1%）患者停药。发生中性粒细胞减少症的患者更可能为女性（p = 0.01）和非吸烟者（p = 0.007），且基线中性粒细胞水平较低（p < 0.0001）。二项式回归分析证实后者（p < 0.0001，B： - 0.491）为中性粒细胞减少症的预测指标。发生中性粒细胞减少症的患者与未发生的患者之间感染率无差异（p = 0.878）。
中性粒细胞减少症在该队列中是常见现象。它通常是轻度、短暂性的，且与感染率增加无关。中性粒细胞减少症的发生与非吸烟、女性性别及较低的基线中性粒细胞水平有关。
