Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands.
RMD Open. 2020 Jul;6(2). doi: 10.1136/rmdopen-2019-001163.
Little is known about relevant events in the at-risk phase of rheumatoid arthritis before the development of clinically apparent inflammatory arthritis (IA). The present study assessed musculoskeletal symptoms, infections and comorbidity in future IA patients.
In a nested case-control study using electronic health records of general practitioners, the frequency and timing of 192 symptoms or diseases were evaluated before a diagnosis of IA, using the International Classification of Primary Care coding system. Cases were 2314 adults with a new diagnosis IA between 2012 and 2016; controls were matched 1:2. The frequency of primary care visits was compared using logistic regression.
The frequency of visits for musculoskeletal symptoms (mostly of shoulders, wrists, fingers and knees) and carpal tunnel syndrome was significantly higher in IA patients vs controls within the final 1.5 years before diagnosis, with ORs of 3.2 (95% CI 2.8 to 3.5), 2.8 (95% CI 2.5 to 3.1) and 2.5 (95% CI 2.2 to 2.8) at 6, 12 and 18 months before diagnosis, respectively. Also, infections (notably of the genital and urinary tracts), IA-comorbidities and chronic diseases were more prevalent in cases than controls, but more evenly spread out over the whole 6-year period before IA. A decision tree was created including all symptoms and diseases.
There was an increased frequency of primary care visits for musculoskeletal symptoms, infections and comorbidities prior to the diagnosis of IA. This diverging trend is present for 4-6 years, but becomes statistically significant 1.5 years before the diagnosis. Validation of these results is warranted.
在出现明显炎症性关节炎（IA）之前，类风湿关节炎（RA）高危期相关事件知之甚少。本研究评估了未来 IA 患者的肌肉骨骼症状、感染和合并症。
在一项使用全科医生电子健康记录的嵌套病例对照研究中，使用初级保健国际分类编码系统评估了 2012 年至 2016 年间 2314 例新诊断为 IA 的成年人在诊断为 IA 之前 192 种症状或疾病的频率和时间。病例为 2314 例新诊断为 IA 的成年人；对照为 1:2 匹配。使用逻辑回归比较初级保健就诊的频率。
在诊断前最后 1.5 年内，IA 患者就诊肌肉骨骼症状（主要是肩部、手腕、手指和膝盖）和腕管综合征的频率明显高于对照组，OR 值分别为 3.2（95%CI 2.8 至 3.5）、2.8（95%CI 2.5 至 3.1）和 2.5（95%CI 2.2 至 2.8）在诊断前 6、12 和 18 个月。此外，IA 合并症和慢性病比对照组更常见，但在 IA 发生前的整个 6 年期间分布更均匀。创建了一个包含所有症状和疾病的决策树。
在诊断为 IA 之前，肌肉骨骼症状、感染和合并症的初级保健就诊频率增加。这种发散趋势持续 4-6 年，但在诊断前 1.5 年变得具有统计学意义。需要验证这些结果。
