Sherrer Y S, Bloch D A, Mitchell D M, Young D Y, Fries J F
Arthritis Rheum. 1986 Apr;29(4):494-500. doi: 10.1002/art.1780290406.
Six hundred eighty-one consecutive patients with rheumatoid arthritis were followed for an average of 11.9 years to identify initial factors that predicted subsequent disability. Of 39 potentially predictive variables obtained at study onset and studied by stepwise regression methods, age was found to be the most powerful single predictor of disability, followed by radiologic grade, sex, and initial functional class. The worst prognosis for disability was found in patients who were older women and who showed radiologic worsening and developed functional impairment early in the disease course. Both disability and radiologic progression of disease were found to develop most rapidly during the first years after disease onset and to assume a slow, nearly linear rate of increase after 10 years. Approximately 10% of patients did not develop significant disability. This study suggests that it is possible to identify, early in the disease course, those patients who are likely to develop severe disability, and that "disease-modifying" therapy might well be initiated earlier in such patients and used consistently throughout the subsequent treatment.
对681例类风湿关节炎连续患者进行了平均11.9年的随访，以确定预测随后残疾的初始因素。在研究开始时获得的39个潜在预测变量并通过逐步回归方法进行研究，发现年龄是残疾最有力的单一预测因素，其次是放射学分级、性别和初始功能分级。残疾预后最差的是老年女性患者，她们在疾病病程早期出现放射学恶化并发展为功能障碍。发现残疾和疾病的放射学进展在疾病发作后的头几年发展最快，10年后呈缓慢、近乎线性的增长速度。约10%的患者未出现明显残疾。这项研究表明，在疾病病程早期有可能识别出那些可能发展为严重残疾的患者，并且“改善病情”疗法很可能在此类患者中更早启动，并在随后的治疗中持续使用。
