Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester.
Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience.
Rheumatology (Oxford). 2022 Nov 28;61(12):4687-4701. doi: 10.1093/rheumatology/keac137.
To identify groups of people with RA with different disability trajectories over 10 years, despite comparable levels of inflammation.
Data for this analysis came from three European prospective cohort studies of people with RA [Norfolk Arthritis Register (NOAR), Early RA Network (ERAN), Étude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR)]. Participants were assessed regularly over 8 (ERAN) to 10 (NOAR/ESPOIR) years. Inclusion criteria were: recruited after 1 January 2000, <24 months baseline symptom duration, and disability (HAQ) and inflammation [two-component DAS28 (DAS28-2C)] recorded at baseline and at one other follow-up. People in each cohort also completed patient-reported outcome measures at each assessment (pain, fatigue, depressive symptoms). Group-based trajectory models were used to identify distinct groups of people with similar HAQ and DAS28-2C trajectories over follow-up.
This analysis included 2500 people with RA (NOAR: 1000, ESPOIR: 766, ERAN: 734). ESPOIR included more women and the participants were younger [mean (standard deviation) age: NOAR: 57.1 (14.6), ESPOIR: 47.6 (12.5), ERAN: 56.8 (13.8); women: NOAR: 63.9%, ESPOIR: 76.9%, ERAN: 69.1%). Within each cohort, two pairs of trajectories following the hypothesized pattern (comparable DAS28-2Cs but different HAQs) were identified. Higher pain, fatigue and depressive symptoms were associated with increased odds of being in the high HAQ trajectories.
Excess disability is persistent in RA. Controlling inflammation may not be sufficient to alleviate disability in all people with RA, and effective pain, fatigue and mood management may be needed in some groups to improve long-term function.
尽管炎症水平相当，但在 10 年内识别出具有不同残疾轨迹的类风湿关节炎患者群体。
本分析的数据来自三项欧洲前瞻性类风湿关节炎队列研究（诺福克关节炎登记处（NOAR）、早期关节炎网络（ERAN）、近期未分化多关节炎研究和随访（ESPOIR））。参与者在 8 至 10 年内定期接受评估（ERAN）。纳入标准为：于 2000 年 1 月 1 日之后招募，基线症状持续时间<24 个月，且残疾（HAQ）和炎症[二分量 DAS28（DAS28-2C）]在基线和另外一次随访时记录。每个队列中的患者还在每次评估时完成患者报告的结局测量（疼痛、疲劳、抑郁症状）。使用基于群组的轨迹模型来识别在随访过程中具有相似 HAQ 和 DAS28-2C 轨迹的不同患者群体。
这项分析包括 2500 名类风湿关节炎患者（NOAR：1000 名，ESPOIR：766 名，ERAN：734 名）。ESPOIR 纳入了更多的女性，参与者年龄更轻[平均（标准差）年龄：NOAR：57.1（14.6），ESPOIR：47.6（12.5），ERAN：56.8（13.8）；女性：NOAR：63.9%，ESPOIR：76.9%，ERAN：69.1%]。在每个队列中，均识别出两组符合假设模式的轨迹（DAS28-2C 相当，但 HAQ 不同）。较高的疼痛、疲劳和抑郁症状与较高的 HAQ 轨迹的几率增加相关。
类风湿关节炎患者的残疾持续存在。控制炎症可能不足以减轻所有类风湿关节炎患者的残疾，在某些患者群体中可能需要有效的疼痛、疲劳和情绪管理，以改善长期功能。
