类风湿关节炎患者随时间推移的身体功能变化：一项队列研究。
Changes in physical function over time in rheumatoid arthritis patients: A cohort study.
机构信息
Laboratório de Doenças Autoimunes, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Santa Cecília, Porto Alegre, Brazil.
Post Graduate Program in Medicine: Medical Sciences, Federal Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
出版信息
PLoS One. 2023 Jan 23;18(1):e0280846. doi: 10.1371/journal.pone.0280846. eCollection 2023.
INTRODUCTION
Self-reported disability is potentially influenced by many factors in patients with rheumatoid arthritis (RA). In this sense, we evaluated the association between self-reported disability and (1) clinical features, (2) muscle strength and (3) physical performance over time among patients with RA from two distinct patient cohorts.
MATERIALS AND METHODS
Two independent prospective RA cohorts were analyzed. The Health Assessment Questionnaire (HAQ), Disease Activity Score in 28 Joints (DAS28), handgrip test, chair stand test, timed-up-and-go (TUG) test and Short Physical Performance Battery (SPPB) were performed at baseline and in follow-up. T test for independent samples, Mann-Whitney U test, Spearman correlation coefficients and linear regression with generalized estimating equations were performed to assess associations between individual constructs at baseline and over time.
RESULTS
A total of 205 total RA patients were included [North American Cohort (n = 115); Brazilian Cohort (n = 90)]. At enrollment, Brazilian men had better HAQ than North American men (p<0.001). Brazilian patients overall had lower muscle strength than North American patients (p<0.05). HAQ was associated with DAS28, handgrip test, chair stand test, TUG and SPPB (p<0.001) in both cohorts. Worsening of the DAS28 and chair stand test were each associated with worsening in HAQ in longitudinal analysis over time. Worsening of handgrip was also associated in with worsening HAQ in both cohorts (p<0.05). A worse TUG test was associated with worsening in HAQ in Brazilian cohort (p<0.05) and a worse SPPB was associated with worsening in HAQ in North American cohort (p<0.05).
CONCLUSION
Greater disability measured by HAQ is closely associated with disease activity, pain, muscle strength, and physical performance among RA. Worsening in self-reported disability correlate with worsening clinical factors including objectively-observed physical function.
简介
在类风湿关节炎（RA）患者中，自我报告的残疾可能受到许多因素的影响。从这个意义上说，我们评估了两个不同 RA 患者队列中，自我报告的残疾与（1）临床特征，（2）肌肉力量和（3）随时间推移的身体表现之间的关联。
材料和方法
分析了两个独立的前瞻性 RA 队列。在基线和随访时进行了健康评估问卷（HAQ）、28 个关节疾病活动评分（DAS28）、握力测试、椅子站立测试、计时起立行走（TUG）测试和简短身体表现电池（SPPB）。采用独立样本 t 检验、Mann-Whitney U 检验、Spearman 相关系数和广义估计方程线性回归来评估基线和随时间变化的个体结构之间的关联。
结果
共纳入 205 例 RA 患者[北美队列（n=115）；巴西队列（n=90）]。在入组时，巴西男性的 HAQ 优于北美男性（p<0.001）。总体而言，巴西患者的肌肉力量低于北美患者（p<0.05）。在两个队列中，HAQ 与 DAS28、握力测试、椅子站立测试、TUG 和 SPPB 相关（p<0.001）。随着 DAS28 和椅子站立测试的恶化，HAQ 在纵向分析中随时间恶化。握力的恶化也与两个队列中 HAQ 的恶化相关（p<0.05）。TUG 测试的恶化与巴西队列中 HAQ 的恶化相关（p<0.05），SPPB 的恶化与北美队列中 HAQ 的恶化相关（p<0.05）。
结论
HAQ 测量的更大残疾与 RA 中的疾病活动、疼痛、肌肉力量和身体表现密切相关。自我报告的残疾恶化与包括客观观察到的身体功能在内的临床因素恶化相关。
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