Wolfe F, Zwillich S H
Arthritis Research Center, and University of Kansas School of Medicine, Wichita 67214, USA.
Arthritis Rheum. 1998 Jun;41(6):1072-82. doi: 10.1002/1529-0131(199806)41:6<1072::AID-ART14>3.0.CO;2-G.
Although total joint arthroplasty (TJA) is a common procedure and an important outcome in rheumatoid arthritis (RA), little is known about its prevalence, failure rate, or predictors over the course of the illness. The current study evaluated these factors in 1,600 consecutive RA patients seen during a period of observation that extended 23 years.
Beginning in 1974, data from 34,040 RA patient visits were entered prospectively into a computer databank. Data consisted of laboratory, radiographic, physical examination, and self-report questionnaires. At each assessment, we also noted a complete surgical history. Patients were also followed up by questionnaires that were mailed at 6-month intervals.
Kaplan-Meier life-table estimates indicated that 25% of RA patients will undergo total joint arthroplasty (TJA) within 21.8 years of disease onset. For patients with 1 TJA, 25% had a TJA in a different joint within 0.92 years and 50% within 7.0 years. Ten years after TJA, approximately 6% of implanted knees and 4% of implanted hips had been replaced with a second TJA, and 12% and 13% of the joints had either a second TJA or a TJA-related operation, respectively. In Cox regressions, a large series of clinical and laboratory variables, which primarily reflected disease activity, predicted TJA. Smoking, either past or present, had a protective effect. Patients with highly abnormal values on the Health Assessment Questionnaire Disability Scale, global severity, and erythrocyte sedimentation rate had a 3-6 times increased risk of TJA.
TJA, a marker of joint failure and of RA outcome, is predicted by self-report assessments of severity and function, and by a series of laboratory, radiographic, and clinical variables. Prediction improves with the extent of observation, and 2-year observations approach full-study observations in their accuracy. Most TJAs survive for a long time in RA.
尽管全关节置换术（TJA）是类风湿关节炎（RA）中的常见手术及一项重要结局，但对于其在疾病过程中的患病率、失败率或预测因素却知之甚少。本研究评估了在长达23年的观察期内就诊的1600例连续RA患者的这些因素。
从1974年开始，前瞻性地将34040例RA患者就诊的数据录入计算机数据库。数据包括实验室检查、影像学检查、体格检查及自我报告问卷。每次评估时，我们还记录完整的手术史。患者还通过每6个月邮寄一次的问卷进行随访。
Kaplan-Meier生存表估计显示，25%的RA患者将在疾病发作后的21.8年内接受全关节置换术（TJA）。对于接受过一次TJA的患者，25%在0.92年内于不同关节进行了TJA，50%在7.0年内进行了TJA。TJA后10年，约6%的植入膝关节和4%的植入髋关节接受了第二次TJA置换，且分别有12%和13%的关节接受了第二次TJA或与TJA相关的手术。在Cox回归分析中，一系列主要反映疾病活动的临床和实验室变量可预测TJA。既往或当前吸烟具有保护作用。健康评估问卷残疾量表、整体严重程度及红细胞沉降率值异常高的患者接受TJA的风险增加3至6倍。
TJA作为关节功能衰竭和RA结局的一个指标，可通过对严重程度和功能的自我报告评估以及一系列实验室、影像学和临床变量进行预测。预测准确性随观察时间延长而提高，2年观察的准确性接近全研究观察。大多数TJA在RA患者中可长期留存。
