Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China.
Shantou University Medical College, Shantou, China.
Int J Rheum Dis. 2019 Sep;22(9):1686-1694. doi: 10.1111/1756-185X.13657. Epub 2019 Jul 22.
Inflammatory joint diseases (IJDs) are chronic arthritis, but frequently present with co-morbidities of other organs and systems, which is known as extra-articular manifestations (EAMs). It is still unclear which clinical characteristics or bio-markers can predict the development of EAMs. The aim of this study was to estimate the proportion of EAMs in southern Chinese patients with IJDs and to explore the risk factors.
This was a retrospective cohort study of a total 1135 IJDs patients, including 788 rheumatoid arthritis (RA) patients, 307 ankylosing spondylitis (AS) patients and 40 psoriatic arthritis (PsA) patients. Demographic data, disease characteristics, laboratory blood tests, medical imaging, and the presence of EAMs were recorded.
We found 459 (40.44%) patients presented with EAMs: 30.84% had cardiovascular involvement, 7.67% had pulmonary involvement, 5.29% had osteoporosis/low bone mineral density, 2.29% had ocular, 0.79% had gastrointestinal and 0.26% had renal involvements. Multivariate logistic regression showed older age (odds ratio [OR] 1.06, P < .001) and higher anti-cyclic citrullinated peptide antibody (anti-CCP) levels (OR 1.003, P = .019) were independent risks of EAMs in RA patients. In the AS group, older age (OR 1.07, P < .001) and higher disease activity (OR 3.24-7.42, both P < .05), were independent risks of EAMs. In the PsA group, longer disease duration (OR 1.01, P = .036) and higher disease activity (OR 1.15, P = .004) were univariate associated factors.
These results suggested the high prevalence of EAMs, and it is important to regularly screen for EAMs, as they influence treatment decisions and impact on patients' quality of life.
炎症性关节疾病(IJDs)是慢性关节炎,但常伴有其他器官和系统的合并症,即关节外表现(EAMs)。目前尚不清楚哪些临床特征或生物标志物可预测 EAMs 的发生。本研究旨在评估中国南方 IJD 患者 EAMs 的比例,并探讨其危险因素。
这是一项回顾性队列研究,共纳入 1135 例 IJD 患者,包括 788 例类风湿关节炎(RA)患者、307 例强直性脊柱炎(AS)患者和 40 例银屑病关节炎(PsA)患者。记录患者的人口统计学数据、疾病特征、实验室血液检查、医学影像学检查以及 EAMs 的发生情况。
我们发现 459 例(40.44%)患者存在 EAMs:30.84%存在心血管受累,7.67%存在肺部受累,5.29%存在骨质疏松/低骨密度,2.29%存在眼部受累,0.79%存在胃肠道受累,0.26%存在肾脏受累。多因素 logistic 回归分析显示,RA 患者中年龄较大(比值比[OR] 1.06,P<.001)和抗环瓜氨酸肽抗体(anti-CCP)水平较高(OR 1.003,P=.019)是 EAMs 的独立危险因素。在 AS 组中,年龄较大(OR 1.07,P<.001)和疾病活动度较高(OR 3.24-7.42,均 P<.05)是 EAMs 的独立危险因素。在 PsA 组中,病程较长(OR 1.01,P=.036)和疾病活动度较高(OR 1.15,P=.004)是单因素相关因素。
这些结果表明 EAMs 的患病率较高,定期筛查 EAMs 非常重要,因为它们会影响治疗决策并影响患者的生活质量。