类风湿关节炎的死亡率

The mortality of rheumatoid arthritis.

作者信息

Wolfe F, Mitchell D M, Sibley J T, Fries J F, Bloch D A, Williams C A, Spitz P W, Haga M, Kleinheksel S M, Cathey M A

机构信息

University of Kansas School of Medicine, Wichita.

出版信息

Arthritis Rheum. 1994 Apr;37(4):481-94. doi: 10.1002/art.1780370408.

DOI:10.1002/art.1780370408

PMID:8147925

Abstract

OBJECTIVE

To determine the risk and causes of death and to quantify mortality predictors in patients with rheumatoid arthritis (RA).

METHODS

RA patients (n = 3,501) from 4 centers (Saskatoon n = 905, Wichita n = 1,405, Stanford n = 886, and Santa Clara n = 305) were followed for up to 35 years; 922 patients died.

RESULTS

The overall standardized mortality ratio (SMR) was 2.26 (Saskatoon 2.24, Wichita 1.98, Stanford 3.08, Santa Clara 2.18) and increased with time. Mortality was strikingly increased for specific causes: infection, lymphoproliferative malignancy, gastroenterologic, and RA. In addition, as an effect of the SMR of 2.26, the expected number of deaths was increased nonspecifically across all causes (except cancer), with a large excess of deaths attributable to cardiovascular and cerebrovascular diseases. Independent predictors of mortality included age, education, male sex, function, rheumatoid factor, nodules, erythrocyte sedimentation rate, joint count, and prednisone use.

CONCLUSION

Mortality rates are increased at least 2-fold in RA, and are linked to clinical severity.

摘要

目的

确定类风湿关节炎（RA）患者的死亡风险及原因，并量化死亡率预测因素。

方法

对来自4个中心（萨斯卡通905例、威奇托1405例、斯坦福886例、圣克拉拉305例）的3501例RA患者进行了长达35年的随访；922例患者死亡。

结果

总体标准化死亡率（SMR）为2.26（萨斯卡通2.24、威奇托1.98、斯坦福3.08、圣克拉拉2.18），且随时间增加。特定原因导致的死亡率显著增加：感染、淋巴增生性恶性肿瘤、胃肠疾病及RA。此外，由于SMR为2.26，所有原因（癌症除外）的预期死亡人数均非特异性增加，心血管和脑血管疾病导致的死亡人数大幅超额。死亡率的独立预测因素包括年龄、教育程度、男性、功能、类风湿因子、结节、红细胞沉降率、关节计数及泼尼松使用情况。