Spector T D, Hart D J, Powell R J
Department of Environmental and Preventive Medicine, St Bartholomew's Hospital Medical College, London, United Kingdom.
Ann Rheum Dis. 1993 Apr;52(4):254-7. doi: 10.1136/ard.52.4.254.
To determine the current prevalence of rheumatoid arthritis (RA) and rheumatoid factor positivity in the United Kingdom middle aged female population and to compare this with previous estimates to assess whether the disease is becoming less prevalent.
A cross sectional prevalence study was undertaken. All women aged 45-64 from the age and sex register of a large 11,000 general practitioner group practice in Chingford, East London were contacted and responders examined clinically and radiographically for the presence of RA by a single observer. Blood was also taken for rheumatoid factor testing (sheep cell agglutination test (SCAT), latex, and IgG). The prevalence in non-attenders was assessed from general practitioner and local hospital records. A diagnosis of definite or classical RA according to 1958 American Rheumatism Association criteria was used, and seropositivity was defined by a SCAT rheumatoid factor of 1/32 or more.
From the 1003 women examined (response rate of 78.8%), 12 women had definite RA (1.2%, 95% confidence interval 0.6 to 1.8). Of these, 7/12 had definite erosive changes on radiography and 3/12 had a positive SCAT (> 1/32). Three cases of RA were also found in the 284 non-responders (prevalence 1.1%) by case-finding techniques. The rate of SCAT positivity in the whole study group was 0.5%. The rates of RA and SCAT positivity currently found in this group were less than those obtained in previous surveys. In the only previous large scale United Kingdom survey, performed in the north of England between 1958 and 1960, 406 women aged 45-64 were examined and 10 cases of definite RA were found, a prevalence of 2.5%. In the patients with RA 68% had erosions and 63% positive SCAT. The population SCAT positive rate in this and other surveys sampled between 1954 and 1961 was in the range of 4-5%, since when there has been a progressive decline according to a number of other studies.
The prevalence of RA and rheumatoid factor in middle aged women is lower than previously believed and supports a variety of other data which indicate that RA is declining in incidence and severity.
确定英国中年女性人群中类风湿关节炎（RA）的当前患病率及类风湿因子阳性率，并将其与先前的估计值进行比较，以评估该疾病的患病率是否正在降低。
开展一项横断面患病率研究。联系了东伦敦钦福德一个拥有11000名患者的大型全科医生团体诊所年龄和性别登记册中所有45 - 64岁的女性，并由一名观察者对应答者进行临床和影像学检查，以确定是否存在RA。同时采集血液进行类风湿因子检测（绵羊细胞凝集试验（SCAT）、乳胶凝集试验和IgG检测）。通过全科医生和当地医院记录评估未应答者的患病率。根据1958年美国风湿病协会标准诊断为明确或典型RA，血清阳性定义为SCAT类风湿因子≥1/32。
在接受检查的1003名女性中（应答率为78.8%），12名女性患有明确的RA（1.2%，95%置信区间为0.6%至1.8%）。其中，12人中有7人在影像学上有明确的侵蚀性改变，12人中有3人SCAT阳性（>1/32）。通过病例发现技术，在284名未应答者中还发现了3例RA（患病率1.1%）。整个研究组的SCAT阳性率为0.5%。该组目前发现的RA和SCAT阳性率低于先前调查的结果。在英国此前唯一一项大规模调查中，于1958年至1960年在英格兰北部进行，检查了406名45 - 64岁女性，发现10例明确的RA，患病率为2.5%。在RA患者中，68%有侵蚀性改变，63%的SCAT阳性。在1954年至1961年间进行的该调查及其他调查中，人群SCAT阳性率在4% - 5%范围内，此后根据其他多项研究显示呈逐渐下降趋势。
中年女性中RA和类风湿因子的患病率低于先前认为的水平，这支持了其他各种表明RA发病率和严重程度正在下降的数据。
