Lindqvist Joakim, Alfredsson Lars, Klareskog Lars, Lampa Jon, Westerlind Helga
Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Karolinska Institutet, Stockholm, Sweden.
ACR Open Rheumatol. 2022 Jun;4(6):492-502. doi: 10.1002/acr2.11422. Epub 2022 Mar 9.
The study objective was to identify subgroups of patients with rheumatoid arthritis (RA) based on their health status 3 years after diagnosis and to assess potential associations to clinical presentation at diagnosis.
This observational study included patients with RA with 3-year follow-up data from the Swedish Epidemiological Investigation of RA study, collected from 2011 to 2018. Hierarchical agglomerative cluster analysis, based on symptoms of pain, fatigue, sleep quality, mood disturbances, and overall health-related quality of life (HRQoL), was used to identify subgroups 3 years after diagnosis. Modified Poisson regression was used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for the associations between the subgroups and patient characteristics at diagnosis.
A total of 1055 individuals constituted the study population, of whom 1011 had complete data on the clustering variables and were therefore eligible for analysis (73% women, median age 58 years). The following three clusters were identified: cluster 1 (466 patients with good health status), cluster 2 (398 patients in an intermediate group), and cluster 3 (147 patients with high levels of pain and fatigue together with markedly impaired HRQoL). Cluster 3 was associated to higher baseline pain (RR: 3.71 [95% CI: 2.14-6.41]), global health (RR: 6.60 [95% CI: 3.53-12.33]), and the Stanford Health Assessment Questionnaire (RR: 4.40 [95% CI: 2.46-7.87]), compared with cluster 1 (highest compared with lowest quartiles). An inverse association was seen for baseline swollen joint count (RR: 0.51 [95% CI: 0.34-0.85]).
A subgroup of patients with RA experience high levels of pain, fatigue, and psychosocial distress 3 years after diagnosis. This subgroup already displayed pronounced pain and functional disabilities at diagnosis.
本研究的目的是根据类风湿关节炎（RA）患者诊断后3年的健康状况确定亚组，并评估其与诊断时临床表现的潜在关联。
这项观察性研究纳入了来自瑞典RA流行病学调查研究的有3年随访数据的RA患者，数据收集于2011年至2018年。基于疼痛、疲劳、睡眠质量、情绪障碍和总体健康相关生活质量（HRQoL）症状，采用分层聚类分析来确定诊断后3年的亚组。采用修正泊松回归来估计亚组与诊断时患者特征之间关联的风险比（RRs）和95%置信区间（CIs）。
共有1055人构成研究人群，其中1011人有聚类变量的完整数据，因此有资格进行分析（73%为女性，中位年龄58岁）。确定了以下三个聚类：聚类1（466名健康状况良好的患者）、聚类2（398名处于中间组的患者）和聚类3（147名疼痛和疲劳程度高且HRQoL明显受损的患者）。与聚类1（最高四分位数与最低四分位数相比）相比，聚类3与更高的基线疼痛（RR：3.71 [95% CI：2.14 - 6.41]）、整体健康（RR：6.60 [95% CI：3.53 - 12.33]）以及斯坦福健康评估问卷评分（RR：4.40 [95% CI：2.46 - 7.87]）相关。观察到基线肿胀关节计数存在负相关（RR：0.51 [95% CI：0.34 - 0.85]）。
一部分RA患者在诊断后3年经历高水平的疼痛、疲劳和心理社会困扰。该亚组在诊断时已表现出明显的疼痛和功能障碍。
