Chen J L, Jin Y B, Wang Y F, Zhang X Y, Li J, Yao H H, He J, Li C
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Dec 18;52(6):1040-1047. doi: 10.19723/j.issn.1671-167X.2020.06.009.
To investigate the clinical characteristics of patients with elderly-onset rheumatoid arthritis (EORA), and the risk factors of EORA complicated with cardiovascular disease (CVD).
A cross-sectional study was conducted in Peking University People's Hospital from July 2009 to December 2014 and 1 116 patients were recruited. The patients' characteristics and CVD, including ischemic heart disease, cerebral and peripheral vascular disease, were recorded. The patients were divided into EORA group (=212) and younger-onset rheumatoid arthritis (YORA) group (=904) according to the age of onset ≥60 years and < 60 years. Then, the differences between the groups were analyzed by Student's test, Mann-Whitney test or test, and risk influencing CVD were analyzed using Logistic regression.
There was no significant difference in the disease activity between the EORA and YORA groups. The proportion of male, pulmonary interstitial disease (ILD), and numbers of deformity joint count (DJC) were significantly higher in the EORA group compared with the YORA group [32.1% . 18.5%, =19.11, < 0.001; 23.6% . 13.6%, =16.50, < 0.001; 6 (2, 12) . 3 (2, 7), =-3.60, < 0.001], while the prevalence of Sjögren's syndrome was lower than that of the YORA group (13.5% . 5.2%, =11.29, =0.001). Moreover, there were lower prevalences in the patients treated with disease-modifying antirheumatic drugs (DMARDs) in EORA group (35.4%) than in YORA group (26.7%) (=6.43, =0.011), especially in methotrexate (MTX), hydroxychloroquine (HCQ) and sulfasalazine (SSZ). In addition, the patients with EORA had a higher prevalence of CVD (27.8%) than the YORA group (11.6%, =40.46, < 0.001), accompanied with higher prevalence of smoking, hypertension, and hyperlipidemia. Multivariate Logistic regression analysis showed that elder age (=1.10, 95%: 1.00-1.20), DJC (=3.17, 95%: 1.04-9.68), rheumatoid nodules (=3.56, 95%: 1.03-12.23), hypertension (=2.37, 95%: 1.09-5.13) and hyperlipidemia (=8.85, 95%: 2.50-31.27) were independent risk factors, while HCQ (=0.22, 95%: 0.07-0.70) and MTX (=0.32, 95%: 0.14-0.73) were protective factors of EORA complicated with CVD.
Compared with YORA, patients with EORA have higher ratio of male, ILD and DJC, which may be attributed to inappropriate therapies. EORA is more likely to be complicated with CVD than YORA. Elder age, DJC, rheumatoid nodules, hypertension, and hyperlipidemia are independent risk factors, while HCQ and MTX are protective factors of EORA complicated with CVD.
探讨老年起病类风湿关节炎（EORA）患者的临床特征以及EORA合并心血管疾病（CVD）的危险因素。
于2009年7月至2014年12月在北京大学人民医院进行一项横断面研究，共纳入1116例患者。记录患者的特征以及CVD情况，包括缺血性心脏病、脑血管和外周血管疾病。根据发病年龄≥60岁和<60岁将患者分为EORA组（n = 212）和年轻起病类风湿关节炎（YORA）组（n = 904）。然后，采用Student's检验、Mann-Whitney检验或卡方检验分析两组之间的差异，并使用Logistic回归分析影响CVD的危险因素。
EORA组和YORA组之间的疾病活动度无显著差异。与YORA组相比，EORA组男性比例、肺间质疾病（ILD）比例和畸形关节计数（DJC）数量显著更高[32.1%对18.5%，χ² = 19.11，P < 0.001；23.6%对13.6%，χ² = 16.50，P < 0.001；6（2，12）对3（2，7），Z = -3.60，P < 0.001]，而干燥综合征的患病率低于YORA组（13.5%对5.2%，χ² = 11.29，P = 0.001）。此外，EORA组接受改善病情抗风湿药物（DMARDs）治疗的患者患病率（35.4%）低于YORA组（26.7%）（χ² = 6.43，P = 0.011），尤其是甲氨蝶呤（MTX）、羟氯喹（HCQ）和柳氮磺吡啶（SSZ）。另外，EORA患者CVD的患病率（27.8%）高于YORA组（11.6%，χ² = 40.46，P < 0.001），同时吸烟、高血压和高脂血症的患病率更高。多因素Logistic回归分析显示，老年（β = 1.10，95%CI：1.00 - 1.20）、DJC（β = 3.17，95%CI：1.04 - 9.68）、类风湿结节（β = 3.56，95%CI：1.03 - 12.23）、高血压（β = 2.37，95%CI：1.09 - 5.13）和高脂血症（β = 8.85，95%CI：2.50 - 31.27）是独立危险因素，而HCQ（β = 0.22，95%CI：0.07 - 0.70）和MTX（β = 0.32，95%CI：0.14 - 0.73）是EORA合并CVD的保护因素。
与YORA相比，EORA患者男性、ILD和DJC的比例更高，这可能归因于治疗不当。EORA比YORA更易合并CVD。老年、DJC、类风湿结节、高血压和高脂血症是独立危险因素，而HCQ和MTX是EORA合并CVD的保护因素。
