Medicine Service, Veterans Affairs (VA) Medical Center, 700 19th Street S, Birmingham, 35233 AL, USA; Department of Medicine at the School of Medicine, University of Alabama at Birmingham, 1720 Second avenue South, Birmingham, 35294-0022 AL, USA; Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, 1720 Second avenue South, Birmingham, 35294-0022 AL, USA.
Department of Medicine at the School of Medicine, University of Alabama at Birmingham, 1720 Second avenue South, Birmingham, 35294-0022 AL, USA.
Joint Bone Spine. 2019 Oct;86(5):615-619. doi: 10.1016/j.jbspin.2019.01.022. Epub 2019 Feb 7.
In the absence of previous studies, our objective was to assess whether gout was associated with an increase or decrease in the risk of Sjogren's Syndrome (SS) in older adults, 65 years or older.
We used the 5% Medicare claims from 2006-2012. A multivariable Cox regression model assessed the association of gout with incident SS adjusting for age, sex, race, Charlson-Romano comorbidity index, and the use of medications for cardiovascular diseases (statins, beta-blockers, diuretics, ACE-inhibitors) and gout (allopurinol, febuxostat). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated.
There were 3,186 new cases of SS in the study cohort with crude incidence rates of SS of 30/100,000 person-years in patients without gout and 49/100,000 person-years in patients with gout. Multivariable-adjusted analyses showed that gout was independently associated with a higher hazard ratio of SS of 1.73 (95% CI, 1.45, 2.06). Sensitivity analyses that substituted continuous Charlson-Romano comorbidity index score with categorized score (model 2) or individual comorbidities plus three common cardiovascular diseases (hypertension, hyperlipidemia, and coronary artery disease; model 3), confirmed the main study findings with minimal attenuation of hazard ratio, 1.70 (95% CI, 1.43, 2.02) and 1.48 (95% CI, 1.25, 1.77), respectively. Younger age, female sex, White race and higher comorbidity score were associated with a higher hazard of SS.
Gout was associated with more than 1.7-fold higher risk of incident SS in adults 65 years or older. This finding needs to be reproduced and the underlying mechanisms for this association need further study.
在缺乏既往研究的情况下，我们的目的是评估痛风是否会增加或降低老年（65 岁及以上）人群患干燥综合征（SS）的风险。
我们使用了 2006 年至 2012 年的 5%医疗保险索赔数据。多变量 Cox 回归模型评估了痛风与 SS 发病风险之间的关联，同时调整了年龄、性别、种族、Charlson-Romano 合并症指数以及心血管疾病药物（他汀类药物、β受体阻滞剂、利尿剂、ACE 抑制剂）和痛风（别嘌醇、非布司他）的使用情况。计算了危险比（HR）和 95%置信区间（CI）。
研究队列中有 3186 例新的 SS 病例，痛风组 SS 的粗发病率为 30/100000 人年，无痛风组为 49/100000 人年。多变量调整分析显示，痛风与 SS 的风险比独立相关，HR 为 1.73（95%CI，1.45，2.06）。敏感性分析用分类评分替代连续 Charlson-Romano 合并症指数评分（模型 2）或个体合并症加三种常见心血管疾病（高血压、高血脂和冠心病；模型 3），结果证实了主要研究结果，HR 分别为 1.70（95%CI，1.43，2.02）和 1.48（95%CI，1.25，1.77），仅略有减弱。年龄较小、女性、白种人和更高的合并症评分与 SS 的发病风险较高相关。
痛风与 65 岁及以上成年人 SS 发病风险增加 1.7 倍以上相关。这一发现需要进一步验证，这种关联的潜在机制需要进一步研究。
