二十多年来强直性脊柱炎发病率、患病率和诊断时间的变化。

Changes in ankylosing spondylitis incidence, prevalence and time to diagnosis over two decades.

机构信息

Leeds Institute for Data Analytics, University of Leeds, Leeds, UK

Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.

出版信息

RMD Open. 2021 Dec;7(3). doi: 10.1136/rmdopen-2021-001888.

DOI:10.1136/rmdopen-2021-001888

PMID:34887345

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8663075/

Abstract

OBJECTIVES

To assess changes in ankylosing spondylitis (AS) incidence, prevalence and time to diagnosis, between 1998 and 2017.

METHODS

Using UK GP data from the Clinical Practice Research Datalink, we identified patients diagnosed with AS between 1998 and 2017. We estimated the annual AS incidence, prevalence and length of time from first recorded symptom of back pain to rheumatology referral and diagnosis.

RESULTS

We identified 12 333 patients with AS. The incidence declined from 0.72 (±0.14) per 10 000 patient-years in 1998 to 0.39 (±0.06) in 2007, with this decline significant only in men, then incidence rose to 0.57 (±0.11) in 2017. By contrast, prevalence increased between 1998 and 2017 (from 0.13%±0.006 to 0.18%±0.006), rising steeply among women (from 0.06%±0.05 to 0.10%±0.06) and patients aged ≥60 (from 0.14%±0.01 to 0.26%±0.01). The overall median time from first symptom to rheumatology referral was 4.87 years (IQR=1.42-10.23). The median time from first symptom to diagnosis rose between 1998 and 2017 (from 3.62 years (IQR=1.14-7.07) to 8.31 (IQR=3.77-15.89)) and was longer in women (6.71 (IQR=2.30-12.36)) than men (5.65 (IQR=1.66-11.20)).

CONCLUSION

AS incidence declined significantly between 1998 and 2007, with an increase between 2007 and 2017 that may be explained by an improvement in the recognition of AS or confidence in diagnosing AS over time, stemming from increased awareness of inflammatory back pain and the importance of early treatment. The rising AS prevalence may indicate improved patient survival. The persisting delay in rheumatology referral and diagnosis remains of concern, particularly in women.

摘要

目的

评估 1998 年至 2017 年间强直性脊柱炎（AS）发病率、患病率和诊断时间的变化。

方法

利用英国临床实践研究数据链（Clinical Practice Research Datalink）中的全科医生数据，我们确定了 1998 年至 2017 年间诊断为 AS 的患者。我们估计了每年 AS 的发病率、患病率，以及从背痛首次记录症状到风湿病转诊和诊断的时间。

结果

我们确定了 12333 名 AS 患者。发病率从 1998 年的每 10000 名患者年 0.72（±0.14）降至 2007 年的 0.39（±0.06），仅在男性中显著下降，然后在 2017 年上升至 0.57（±0.11）。相比之下，患病率在 1998 年至 2017 年间增加（从 0.13%±0.006 增至 0.18%±0.006），在女性（从 0.06%±0.05 增至 0.10%±0.06）和≥60 岁的患者中急剧上升（从 0.14%±0.01 增至 0.26%±0.01）。从首次症状到风湿病转诊的总体中位数时间为 4.87 年（IQR=1.42-10.23）。从首次症状到诊断的中位数时间在 1998 年至 2017 年间延长（从 3.62 年（IQR=1.14-7.07）延长至 8.31 年（IQR=3.77-15.89）），女性（6.71 年（IQR=2.30-12.36））比男性（5.65 年（IQR=1.66-11.20））更长。

结论

1998 年至 2007 年间 AS 发病率显著下降，2007 年至 2017 年间上升，这可能是由于随着时间的推移，对 AS 的认识或诊断 AS 的信心有所提高，这源于对炎症性背痛的认识不断提高，以及对早期治疗的重视。AS 的患病率不断上升可能表明患者的生存率提高。风湿病转诊和诊断的持续延迟仍然令人担忧，特别是在女性中。