T.M. Gunderson, MS, Department of Health Sciences Research, Mayo Clinic, Rochester.
E. Myasoedova, MD, PhD, C.S. Crowson, PhD, Department of Health Sciences Research, and Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester.
J Rheumatol. 2021 Nov;48(11):1648-1654. doi: 10.3899/jrheum.200971. Epub 2021 Feb 15.
To estimate the prevalence and incidence of multimorbidity (MM) in a population-based cohort of patients with rheumatoid arthritis (RA) compared to subjects without RA.
Between 1999-2013, residents of Olmsted County, Minnesota with incident RA who met the 1987 American College of Rheumatology criteria were compared to age- and sex-matched non-RA subjects from the same population. Twenty-five chronic comorbidities from a combination of the Charlson, Elixhauser, and Rheumatic Disease Comorbidity Indices were included, excluding rheumatic comorbidities. The Aalen-Johansen method was used to estimate the cumulative incidence of MM (MM2+; ≥ 2 chronic comorbidities) or substantial MM (MM5+; ≥ 5), adjusting for the competing risk of death.
The study included 597 patients with RA and 594 non-RA subjects (70% female, 90% White, mean age 55.5 yrs). At incidence/index date, the prevalence of MM2+ was higher in RA than non-RA subjects (38% RA vs 32% non-RA, = 0.02), whereas prevalence of MM5+ was similar (5% RA vs. 4% non-RA, = 0.68). During follow-up (median 11.6 yrs RA, 11.3 yrs non-RA), more patients with RA developed MM2+ (214 RA vs 188 non-RA; adjusted HR 1.39, 95% CI 1.14-1.69). By 10 years after RA incidence/index, the cumulative incidence of MM2+ was 56.5% among the patients with RA (95% CI 56.5-62.3%) compared with 47.9% among the non-RA (95% CI 42.8-53.7%). Patients with RA showed no evidence of increase in incidence of MM5+ (adjusted HR 1.17, 95% CI 0.93-1.47).
Patients with RA have both a higher prevalence of MM at the time of RA incidence as well as increased incidence thereafter.
在类风湿关节炎（RA）患者的基于人群队列中，与无 RA 的患者相比，估计多种合并症（MM）的患病率和发病率。
1999-2013 年，在明尼苏达州奥姆斯特德县发现的符合 1987 年美国风湿病学会标准的 RA 患者与同一人群中年龄和性别匹配的非 RA 患者进行了比较。纳入了 Charlson、Elixhauser 和风湿性疾病合并症指数的组合中的 25 种慢性合并症，不包括风湿性合并症。使用 Aalen-Johansen 方法估计 MM（MM2+；≥2 种慢性合并症）或大量 MM（MM5+；≥5 种）的累积发病率，调整死亡的竞争风险。
研究纳入了 597 例 RA 患者和 594 例非 RA 患者（70%为女性，90%为白人，平均年龄为 55.5 岁）。在发病/指数日期，RA 患者的 MM2+患病率高于非 RA 患者（38%RA 比 32%非 RA， = 0.02），而 MM5+的患病率相似（5%RA 比 4%非 RA， = 0.68）。在随访期间（RA 中位数为 11.6 年，非 RA 中位数为 11.3 年），更多的 RA 患者发生了 MM2+（214 例 RA 比 188 例非 RA；调整后的 HR 为 1.39，95%CI 为 1.14-1.69）。在 RA 发病/指数后 10 年，RA 患者的 MM2+累积发病率为 56.5%（95%CI 为 56.5-62.3%），而非 RA 患者为 47.9%（95%CI 为 42.8-53.7%）。RA 患者的 MM5+发病率无增加迹象（调整后的 HR 为 1.17，95%CI 为 0.93-1.47）。
RA 患者在发病时既有更高的 MM 患病率，发病后又有更高的发病率。
