Centre for Rheumatic Diseases and School of Life Course Sciences, King's College London, The Medical Eye Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK, and the Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Arthritis Rheumatol. 2021 Jul;73(7):1267-1276. doi: 10.1002/art.41709. Epub 2021 Jun 6.
To estimate 22-year trends in the prevalence and incidence of scleritis, and the associations of scleritis with infectious and immune-mediated inflammatory diseases (I-IMIDs) in the UK.
The retrospective cross-sectional and population cohort study (1997-2018) included 10,939,823 patients (2,946 incident scleritis cases) in The Health Improvement Network, a nationally representative primary care records database. The case-control and matched cohort study (1995-2019) included 3,005 incident scleritis cases and 12,020 control patients matched by age, sex, region, and Townsend deprivation index. Data were analyzed using multivariable Poisson regression, multivariable logistic regression, and Cox proportional hazards multivariable models adjusted for age, sex, Townsend deprivation index, race/ethnicity, smoking status, nation within the UK, and body mass index. Incidence rate ratios (IRRs) and 95% confidence intervals (95% CIs) were calculated.
Scleritis incidence rates per 100,000 person-years declined from 4.23 (95% CI 2.16-6.31) to 2.79 (95% CI 2.19-3.39) between 1997 and 2018. The prevalence of scleritis per 100,000 person-years was 93.62 (95% CI 90.17-97.07) in 2018 (61,650 UK patients). Among 2,946 patients with incident scleritis, 1,831 (62.2%) were female, the mean ± SD age was 44.9 ± 17.6 years (range 1-93), and 1,257 (88.8%) were White. Higher risk of incident scleritis was associated with female sex (adjusted IRR 1.53 [95% CI 1.43-1.66], P < 0.001), Black race/ethnicity (adjusted IRR 1.52 [95% CI 1.14-2.01], P = 0.004 compared to White race/ethnicity), or South Asian race/ethnicity (adjusted IRR 1.50 [95% CI 1.19-1.90], P < 0.001 compared to White race/ethnicity), and older age (peak adjusted IRR 4.95 [95% CI 3.99-6.14], P < 0.001 for patients ages 51-60 years versus those ages ≤10 years). Compared to controls, scleritis patients had a 2-fold increased risk of a prior I-IMID diagnosis (17 I-IMIDs, P < 0.001) and significantly increased risk of subsequent diagnosis (13 I-IMIDs). The I-IMIDs most strongly associated with scleritis included granulomatosis with polyangiitis, Behçet's disease, and Sjögren's syndrome.
From 1997 through 2018, the UK incidence of scleritis declined from 4.23 to 2.79/100,000 person-years. Incident scleritis was associated with 19 I-IMIDs, providing data for rational investigation and cross-specialty engagement.
评估英国巩膜炎在 22 年内的患病率和发病率趋势，以及巩膜炎与传染性和免疫介导的炎症性疾病（I-IMIDs）之间的关联。
这项回顾性的横断面和人群队列研究（1997-2018 年）纳入了来自国家代表性初级保健记录数据库 Health Improvement Network 的 10939823 名患者（2946 例巩膜炎新发病例）。病例对照和匹配队列研究（1995-2019 年）纳入了 3005 例新发病例和 12020 例对照患者，这些患者按照年龄、性别、地区和汤森贫困指数进行匹配。使用多变量泊松回归、多变量逻辑回归和 Cox 比例风险多变量模型分析数据，模型中调整了年龄、性别、汤森贫困指数、种族/民族、吸烟状况、英国境内的国家和体重指数。计算了发病率比（IRR）和 95%置信区间（95%CI）。
1997 年至 2018 年间，巩膜炎的发病率从 4.23/100000 人年降至 2.79/100000 人年。2018 年，巩膜炎的患病率为每 100000 人年 93.62（95%CI 90.17-97.07）（61650 名英国患者）。在 2946 例新发病例中，1831 例（62.2%）为女性，平均年龄±标准差为 44.9±17.6 岁（范围 1-93），1257 例（88.8%）为白人。巩膜炎新发病例的风险较高与女性（调整后的 IRR 1.53[95%CI 1.43-1.66]，P<0.001）、黑人种族/民族（调整后的 IRR 1.52[95%CI 1.14-2.01]，与白人种族/民族相比，P=0.004）或南亚种族/民族（调整后的 IRR 1.50[95%CI 1.19-1.90]，与白人种族/民族相比，P<0.001）以及年龄较大（调整后的最大 IRR 4.95[95%CI 3.99-6.14]，与≤10 岁的患者相比，51-60 岁的患者）相关。与对照组相比，巩膜炎患者发生 I-IMIDs 诊断的风险增加了两倍（17 种 I-IMIDs，P<0.001），随后发生诊断的风险显著增加（13 种 I-IMIDs）。与巩膜炎最相关的 I-IMIDs 包括肉芽肿性多血管炎、贝赫切特病和干燥综合征。
1997 年至 2018 年间，英国巩膜炎的发病率从 4.23 降至 2.79/100000 人年。巩膜炎与 19 种 I-IMIDs 相关，为合理调查和跨专业合作提供了数据。
