急性焦磷酸钙结晶性关节炎发作率和复发的危险因素。
Acute Calcium Pyrophosphate Crystal Arthritis Flare Rate and Risk Factors for Recurrence.
机构信息
From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School.
出版信息
J Rheumatol. 2020 Aug 1;47(8):1261-1266. doi: 10.3899/jrheum.190778. Epub 2019 Nov 1.
OBJECTIVE
Little is known about acute calcium pyrophosphate (CPP) crystal arthritis flare rates and risk factors for recurrence. We characterized flares and determined the rate and predictors of acute CPP crystal arthritis flares in an academic medical center cohort.
METHODS
We performed a retrospective cohort study among a random sample of patients with acute CPP crystal arthritis identified in the Partners HealthCare electronic medical record, 1991-2017. Flare was defined as self-limited, acute-onset synovitis with synovial fluid CPP crystals and/or chondrocalcinosis, not better explained by another cause. We calculated incidence rates (IR) for acute CPP crystal arthritis flare among all subjects and by sex. We estimated HR for recurrent flare using univariate Cox models that accounted for within-person correlated data.
RESULTS
We identified 70 patients with acute CPP crystal arthritis with a total of 111 flares. Recurrent flares occurred in 24% of patients; half of flares occurred in a previously unaffected joint. The acute CPP crystal arthritis flare rate was 11.4 per 100 person-years overall (95% CI 8.2-15.4), 14.2 in women (95% CI 9.6-0.1), and 7.1 in men (95% CI 3.4-13.0). Cancer (HR 2.98, 95% CI 1.33-6.68) and chronic kidney disease (HR 2.92, 95% CI 1.10-7.76) were associated with a higher rate for recurrent flare.
CONCLUSION
Recurrent flares occurred in about one-fourth of patients with acute CPP crystal arthritis and often occurred in previously unaffected joints. The acute CPP crystal arthritis flare rate was twice as high in women as in men.
目的
对于急性焦磷酸钙（CPP）晶体关节炎发作率和复发的危险因素知之甚少。我们对发作进行了特征描述，并确定了学术医疗中心队列中急性 CPP 晶体关节炎发作的发生率和预测因素。
方法
我们对 1991 年至 2017 年间在 Partners HealthCare 电子病历中随机抽取的急性 CPP 晶体关节炎患者进行了回顾性队列研究。发作定义为自限性、急性发作的滑膜炎，伴有滑液 CPP 晶体和/或软骨钙质沉着症，不能用其他原因更好地解释。我们计算了所有受试者和按性别划分的急性 CPP 晶体关节炎发作的发生率（IR）。我们使用单变量 Cox 模型估计了复发性发作的 HR，该模型考虑了个体内相关数据。
结果
我们共确定了 70 例急性 CPP 晶体关节炎患者，共发生了 111 例发作。复发发作发生在 24%的患者中；一半的发作发生在以前未受影响的关节。总的来说，急性 CPP 晶体关节炎发作率为 11.4 例/100 人年（95%CI8.2-15.4），女性为 14.2 例/100 人年（95%CI9.6-0.1），男性为 7.1 例/100 人年（95%CI3.4-13.0）。癌症（HR2.98，95%CI1.33-6.68）和慢性肾脏病（HR2.92，95%CI1.10-7.76）与更高的复发率相关。
结论
约四分之一的急性 CPP 晶体关节炎患者出现复发发作，且常发生在以前未受影响的关节。女性的急性 CPP 晶体关节炎发作率是男性的两倍。
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