类风湿关节炎发病患者发生痴呆的风险因素：一项基于人群的队列研究。
Risk Factors for Dementia in Patients With Incident Rheumatoid Arthritis: A Population-Based Cohort Study.
机构信息
C. Kodishala, MBBS, DM, V.L. Kronzer, MD, MSCI, J.M. Davis III, MD, Division of Rheumatology, Mayo Clinic.
C.A. Hulshizer, BA, Department of Quantitative Health Sciences, Mayo Clinic.
出版信息
J Rheumatol. 2023 Jan;50(1):48-55. doi: 10.3899/jrheum.220200. Epub 2022 Jul 15.
OBJECTIVE
Growing evidence suggests that patients with rheumatoid arthritis (RA) have increased risk for dementia. We assessed risk factors for incident dementia in an inception cohort of patients with RA.
METHODS
This retrospective population-based cohort study included residents of 8 counties in Minnesota who were ≥ 50 years of age when they met 1987 American College of Rheumatology criteria for incident RA between 1980 and 2014 and were followed until death/migration or December 31, 2019. Patients with dementia before RA incidence were excluded. Incident dementia was defined as 2 relevant International Classification of Diseases, 9th or 10th revision codes at least 30 days apart. Data on sociodemographics, disease characteristics, cardiovascular/cerebrovascular disease (CVD) risk factors, and comorbidities were abstracted from medical records.
RESULTS
The study included 886 patients with RA (mean age 65.1 yrs, 65.2% female). During the follow-up period (median 8.5 yrs), 103 patients developed dementia. After adjusting for age, sex, and calendar year of RA incidence, older age at RA incidence (HR 1.14 per 1 year increase, 95% CI 1.12-1.17), rheumatoid nodules (HR 1.76, 95% CI 1.05-2.95), hypertension (HR 1.84, 95% CI 1.19-2.85), presence of large joint swelling (HR 2.03, 95% CI 1.14-3.60), any CVD (HR 2.25, 95% CI 1.38-3.66), particularly ischemic stroke (HR 3.16, 95% CI 1.84-5.43) and heart failure (HR 1.82, 95% CI 1.10-3.00), anxiety (HR 1.86, 95% CI 1.16-2.97), and depression (HR 2.63, 95% CI 1.76-3.93) were associated with increased risk of dementia. After adjusting for CVD risk factors and any CVD, all covariates listed above were still significantly associated with risk of dementia.
CONCLUSION
Apart from age, hypertension, depression, and anxiety, all of which are universally recognized risk factors for dementia, clinically active RA and presence of CVD were associated with an elevated risk of dementia incidence among patients with RA.
目的
越来越多的证据表明，类风湿关节炎（RA）患者痴呆的风险增加。我们评估了在一个 RA 发病队列中痴呆发病的危险因素。
方法
这是一项回顾性的基于人群的队列研究，包括明尼苏达州 8 个县的居民，他们在 1980 年至 2014 年间符合 1987 年美国风湿病学会的 RA 发病标准时年龄≥50 岁，并在发病后随访至死亡/迁移或 2019 年 12 月 31 日。排除 RA 发病前患有痴呆的患者。痴呆的定义为至少相隔 30 天的两次相关的国际疾病分类，第 9 或第 10 修订版代码。从病历中提取社会人口统计学、疾病特征、心血管/脑血管疾病（CVD）危险因素和合并症的数据。
结果
该研究纳入了 886 名 RA 患者（平均年龄 65.1 岁，65.2%为女性）。在随访期间（中位 8.5 年），有 103 名患者发生痴呆。在调整年龄、性别和 RA 发病的年份后，RA 发病时年龄较大（每增加 1 岁，HR 1.14，95%CI 1.12-1.17）、类风湿结节（HR 1.76，95%CI 1.05-2.95）、高血压（HR 1.84，95%CI 1.19-2.85）、大关节肿胀（HR 2.03，95%CI 1.14-3.60）、任何 CVD（HR 2.25，95%CI 1.38-3.66），特别是缺血性中风（HR 3.16，95%CI 1.84-5.43）和心力衰竭（HR 1.82，95%CI 1.10-3.00）、焦虑（HR 1.86，95%CI 1.16-2.97）和抑郁（HR 2.63，95%CI 1.76-3.93）与痴呆风险增加相关。在调整 CVD 危险因素和任何 CVD 后，上述所有协变量与痴呆风险仍显著相关。
结论
除了年龄、高血压、抑郁和焦虑这些普遍被认为是痴呆的危险因素外，临床活动期 RA 和 CVD 的存在与 RA 患者痴呆发生率的升高有关。
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