Suarez-Almazor M E, Soskolne C L, Saunders L D, Russell A S
Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada.
J Rheumatol. 1994 Aug;21(8):1438-46.
Our purpose was to describe the clinical status and outcome of a 1985 inception cohort of patients with rheumatoid arthritis (RA), retrospectively established.
All patients with RA in Edmonton, with a possible onset of disease in 1985, and who consulted a rheumatologist at any time from January, 1985 through June, 1991 were considered for inclusion in the cohort. Patients were contacted and assessed between August, 1991 and June, 1992. The following indices were used as outcome measures: joint counts, radiological scores of hand radiographs and the modified Health Assessment Questionnaire for activities of daily living (MHAQ).
One hundred and twenty eight patients were included in the cohort (70% were women; age at onset was 52 +/- 13 years). At the time of the assessment, 41 patients (32%) had no articular swelling. Twenty-nine patients (23%) had a radiological score of 0, and 39 (31%) had no erosions. The mean MHAQ score was 0.49 +/- 0.47; 39 patients (31%) had a score of 0 (normal function). Rheumatoid factors and nodules were related to more severe outcomes. Sex, age at onset and mode of onset were not related to prognosis. Most patients had received 2nd line therapy within the first 3 years of RA.
Our results suggest that the prognosis of RA after 6-7 years of disease is not as ominous as has been suggested by others. Since most of the previous studies have been conducted in prevalent cases attending tertiary centers, a selection bias may be responsible for some of these results. Since these patients were treated early in the course of the disease, the beneficial effects of prompt 2nd line therapy cannot be excluded.
我们的目的是描述一个1985年起始队列的类风湿关节炎（RA）患者的临床状况和结局，该队列是回顾性建立的。
埃德蒙顿所有可能在1985年发病且在1985年1月至1991年6月期间任何时间咨询过风湿病学家的RA患者均被考虑纳入该队列。在1991年8月至1992年6月期间对患者进行了联系和评估。以下指标用作结局测量：关节计数、手部X线片的放射学评分以及用于日常生活活动的改良健康评估问卷（MHAQ）。
该队列纳入了128名患者（70%为女性；发病年龄为52±13岁）。在评估时，41名患者（32%）无关节肿胀。29名患者（23%）的放射学评分为0，39名患者（31%）无侵蚀。MHAQ平均评分为0.49±0.47；39名患者（31%）评分为0（功能正常）。类风湿因子和结节与更严重的结局相关。性别、发病年龄和发病方式与预后无关。大多数患者在RA发病的前3年内接受了二线治疗。
我们的结果表明，疾病6 - 7年后RA的预后并不像其他人所认为的那样凶险。由于之前的大多数研究是在三级中心就诊的现患病例中进行的，一些结果可能存在选择偏倚。由于这些患者在疾病过程中早期接受了治疗，不能排除早期二线治疗的有益效果。
