Corbett M, Dalton S, Young A, Silman A, Shipley M
Bloomsbury Rheumatology Unit, Middlesex Hospital, London.
Br J Rheumatol. 1993 Aug;32(8):717-23. doi: 10.1093/rheumatology/32.8.717.
Sixty-four survivors from a prospective study of early rheumatoid disease were assessed again at a mean of 15.2 years from presentation and their status compared with 29 patients who had died. Eleven of the dead and only two of the survivors had been treated with steroids. There was a small increase in mortality due to the disease itself but only one death was directly caused by it. As might be expected, those who died were older. In the first year of disease, they had lower haemoglobin levels, a lower body mass, higher sedimentation rates and higher levels of blood urea. One-fifth at entry to the study and two-fifths by the time of death, had poor functional capacity. Of 64 survivors, six had poor functional capacity at entry and nine after 15 years. Discriminant analysis was performed to identify the most powerful combination of early features predicting a poor functional outcome. A combination including early erosive change, seropositivity, poor grip strength and cervical subluxation predicted the outcome correctly in 73% of survivors. Almost 60% of survivors remained with or improved to normal function at 15 years suggesting that morbidity is not as bad as has been suggested in the past.
对一项早期类风湿性疾病前瞻性研究中的64名幸存者进行了再次评估，评估时间距疾病初发平均为15.2年，并将他们的状况与29名已死亡患者进行了比较。死亡患者中有11人、幸存者中仅有2人曾接受过类固醇治疗。疾病本身导致的死亡率略有上升，但直接由该疾病导致的死亡仅有1例。不出所料，死亡患者年龄更大。在疾病的第一年，他们的血红蛋白水平较低、体重较轻、血沉较高且血尿素水平较高。研究开始时五分之一的患者以及到死亡时五分之二的患者功能能力较差。在64名幸存者中，6人在研究开始时功能能力较差，15年后有9人功能能力较差。进行判别分析以确定预测功能预后不良的最有力早期特征组合。包括早期侵蚀性改变、血清学阳性、握力差和颈椎半脱位的组合在73%的幸存者中正确预测了结果。近60%的幸存者在15年后仍保持或改善至正常功能，这表明发病率并不像过去所认为的那么糟糕。
