Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå Sweden; Academic Specialist Center, Center for Rheumatology, Health Care Services Stockholm County (SLSO), Stockholm, Sweden.
Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå Sweden.
Eur J Intern Med. 2024 Aug;126:95-101. doi: 10.1016/j.ejim.2024.04.026. Epub 2024 May 4.
Rheumatoid arthritis [RA) is a chronic inflammatory disease, with potential for extra-articular manifestations (ExRA). The incidence and predisposing factors for ExRA and the mortality were evaluated in an early RA inception cohort.
Patients (n = 1468; 69 % females, mean age (SD) 57.3(16.3) years) were consecutively included at the date of diagnosis, between 1 January 1996 and 31 December 2016, and assessed prospectively. In December 2016 development of ExRA was evaluated by a patient questionnaire and a review of medical records. Cumulative incidence and incidence rates were compared between 5-year periods and between patients included before and after 1 January 2001. Cox proportional hazard regression models were used to identify predictors for ExRA, and models with ExRA as time-dependent variables to estimate the mortality.
After a mean (SD) follow-up of 9.3(4.9) years, 238 cases (23.3 %) had ExRA and 151 (14.7 %) had ExRA without rheumatoid nodules. Most ExRA developed within 5 years from diagnosis. Rheumatoid nodules (10.5 %) and keratoconjunctivitis sicca (7.1 %) were the most frequent manifestations, followed by pulmonary fibrosis (6.1 %). The ExRA incidence among more recently diagnosed patients was similar as to the incidence among patients diagnosed before 2001. Seropositivity, smoking and early biological treatment were associated with development of ExRA. After 15 years 20 % had experienced ExRA. ExRA was associated with increased mortality, HR 3.029 (95 % CI 2.177-4.213).
Early development of ExRA is frequent, particularly rheumatoid nodules. Predisposing factors were age, RF positivity, smoking and early biological treatment. The patients with ExRA had a 3-fold increase in mortality.
类风湿关节炎（RA）是一种慢性炎症性疾病，可能出现关节外表现（ExRA）。本研究评估了早期 RA 发病队列中 ExRA 的发病情况、潜在的诱发因素和死亡率。
本研究共纳入 1468 例患者（69%为女性，平均年龄 57.3±16.3 岁），这些患者均于 1996 年 1 月 1 日至 2016 年 12 月 31 日期间连续确诊，并进行前瞻性评估。2016 年 12 月，通过患者问卷调查和病历回顾评估 ExRA 的发病情况。比较了 5 年期间和 2001 年 1 月 1 日之前和之后纳入的患者之间的累积发病率和发病率。使用 Cox 比例风险回归模型来确定 ExRA 的预测因素，并使用包含 ExRA 的模型作为时间依赖性变量来估计死亡率。
平均（SD）随访 9.3（4.9）年后，238 例（23.3%）患者出现 ExRA，151 例（14.7%）患者出现类风湿结节以外的 ExRA。大多数 ExRA 发生在诊断后 5 年内。最常见的表现为类风湿结节（10.5%）和干燥性角结膜炎（7.1%），其次是肺纤维化（6.1%）。与 2001 年之前确诊的患者相比，最近确诊的患者的 ExRA 发病率相似。血清学阳性、吸烟和早期生物治疗与 ExRA 的发生有关。15 年后，20%的患者经历了 ExRA。ExRA 与死亡率增加相关，HR 为 3.029（95%CI 2.177-4.213）。
ExRA 的早期发生较为频繁，尤其是类风湿结节。危险因素包括年龄、RF 阳性、吸烟和早期生物治疗。患有 ExRA 的患者死亡率增加了 3 倍。
