Bala Valentina, Hafström Ingiäld, Svensson Björn, Ajeganova Sofia
Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
Department of Medicine, Section of Rheumatology, Helsingborg Hospital, Helsingborg, Sweden.
RMD Open. 2025 Jan 21;11(1):e004744. doi: 10.1136/rmdopen-2024-004744.
To assess patient's self-reported global assessment of health (PGA) in relation to inflammation, pain and disability in patients with rheumatoid arthritis (RA).
Data were obtained from the Better Anti-Rheumatic PharmacOTherapy early RA cohort, in which patients were scheduled for follow-up of 15 years. Longitudinal PGA trajectories were identified using hierarchical agglomerative clustering procedure with Wards methods, based on PGA assessments during the first 2 years. Multivariate linear regression and mixed models were used to evaluate associations between PGA, inflammation, pain and disability.
Totally 2238 patients were included in 1991-2006. Three PGA trajectories were identified, low, medium and high, including 34%, 48% and 18% of the patients, respectively. The similar PGA patterns were shown for the inclusion periods before and after 1999. The patients in the low PGA group were less often women, had lower body mass index, lower levels of inflammatory variables, visual analogue scale (VAS) pain and Health Assessment Questionnaire (HAQ) scores at baseline than patients in the higher PGA groups. After adjustments, smoking and antibodies to cyclic citrullinated peptide status differentiated between being in low and high PGA groups. During the first year, all PGA groups showed improved outcomes, most pronounced in low PGA group. Fewer patients in high PGA group achieved remission, independent of remission criteria used. The outcomes were consistently different between the PGA groups from 6 months and onwards. The PGA levels from baseline over 15 years were best explained by VAS pain, followed by HAQ score, Disease Activity Score on 28 joints-3 and tender joint count, adjusted R up to 77%, 41%, 27% and 26%, respectively.
Persistently higher PGA levels in RA were mostly related to pain and disability.
评估类风湿关节炎（RA）患者自我报告的整体健康评估（PGA）与炎症、疼痛和残疾之间的关系。
数据取自更好的抗风湿药物治疗早期RA队列，该队列中的患者计划进行15年的随访。基于前2年的PGA评估，使用Wards方法的层次凝聚聚类程序确定纵向PGA轨迹。采用多元线性回归和混合模型评估PGA、炎症、疼痛和残疾之间的关联。
1991年至2006年共纳入2238例患者。确定了三种PGA轨迹，即低、中、高，分别包括34%、48%和18%的患者。1999年前后的纳入期显示出相似的PGA模式。低PGA组的患者女性较少，体重指数较低，基线时炎症变量水平、视觉模拟量表（VAS）疼痛和健康评估问卷（HAQ）评分均低于高PGA组的患者。调整后，吸烟和抗环瓜氨酸肽抗体状态在低PGA组和高PGA组之间存在差异。在第一年，所有PGA组的结局均有所改善，在低PGA组中最为明显。高PGA组达到缓解的患者较少，与所使用的缓解标准无关。从6个月及以后，PGA组之间的结局始终存在差异。15年中从基线开始的PGA水平最好由VAS疼痛解释，其次是HAQ评分、28个关节疾病活动评分-3和压痛关节计数，调整后的R分别高达77%、41%、27%和26%。
RA患者持续较高的PGA水平主要与疼痛和残疾有关。
