Central Finland Central Hospital Rheumatology Outpatient Clinic, Jyväskylä, Finland.
Clin Exp Rheumatol. 2023 Jan;41(1):151-158. doi: 10.55563/clinexprheumatol/kruuqi. Epub 2022 Jun 28.
To study 10-year outcomes in patients with early seropositive rheumatoid arthritis (RA) whether the outcomes improve over time.
Data of 1754 patients with early RA, diagnosed in 1997-2011 were explored; 66% (n=1151) were seropositive and included in the analyses. Patients were divided into five groups by diagnosis year: 1997-1999, 2000-2002, 2003-2005, 2006-2008 and 2009-2011. Clinical parameters including disease activity and function were compared between the groups.
A total of 832 (72%) patients attended the 10-year visit, while 319 did not (e.g. 196 had died and 49 moved). The median (IQR) DAS28 decreased from 2.9 (2.2, 3.7) to 2.3 (1.4, 3.0) (p<0.001) between groups 1997-1999 and 2009-2011. The proportion of patients with 2 or more swollen joints on 46 joint count decreased from 33% to 13%, respectively. Median (IQR) pain decreased from 30 (15, 52) to 25 (6, 51) (p=0.03) and fatigue from 31 (12, 52) to 15 (2, 50) (p=0.012). Median (IQR) dr.global decreased from 20 (5, 40) to 0 (0, 5) p<0.001. The proportion of patients with a HAQ-score of ≤0.5 increased from 39% to 49% (p=0.002). The proportion of patients that had used methotrexate by the 10-year visit increased from 79% to 96% (p<0.001) and the proportion of patients who had used bDMARDs increased from 11% to 28% (p=0.001), respectively.
Several clinical outcomes were better in patients who were diagnosed more recently. More intensive use of medications over time might have contributed to these improvements.
研究早期血清阳性类风湿关节炎（RA）患者的 10 年结局，观察这些结局是否随时间改善。
本研究纳入了 1997 年至 2011 年期间确诊的 1754 例早期 RA 患者的数据；其中 66%（n=1151）为血清阳性患者，纳入本分析。患者按诊断年份分为五组：1997-1999 年、2000-2002 年、2003-2005 年、2006-2008 年和 2009-2011 年。比较各组间疾病活动度和功能等临床参数。
共有 832 例（72%）患者完成了 10 年随访，319 例（例如 196 例死亡，49 例搬迁）未完成。DAS28 中位数（IQR）从 1997-1999 年组的 2.9（2.2，3.7）降至 2009-2011 年组的 2.3（1.4，3.0）（p<0.001）。46 关节计数肿胀关节数≥2 个的患者比例从 33%降至 13%。疼痛中位数（IQR）从 30（15，52）降至 25（6，51）（p=0.03），疲劳从 31（12，52）降至 15（2，50）（p=0.012）。dr.global 中位数（IQR）从 20（5，40）降至 0（0，5）（p<0.001）。HAQ 评分≤0.5 的患者比例从 39%升至 49%（p=0.002）。10 年随访时，接受甲氨蝶呤治疗的患者比例从 79%升至 96%（p<0.001），接受生物 DMARDs 治疗的患者比例从 11%升至 28%（p=0.001）。
最近诊断的患者的多项临床结局更好。随着时间的推移，药物的使用更加密集，可能促成了这些改善。
