目的

我們研究的目的是調查近年來確診為類風濕關節炎(RA)的患者是否以及何時出現死亡風險增加。

方法

通過大量登記聯係的方式，我們設計了一項關於瑞典人口的全國性隊列研究。來自瑞典風濕病學質量登記冊的初發RA患者以及匹配的一般對照人群根據登記的總人口記錄死亡率。

結果

從1997年1月1日至2014年12月31日期間，有17 512例初發RA患者，以及78 847例匹配的一般對照人群，從診斷RA開始隨訪至死亡、移民或2015年12月31日為止。在RA隊列和一般人群中，隨著時間推移，絕對死亡率穩步下降。在RA診斷後的所有時期，RA組的死亡相對危險度無增加(HR = 1.01,95%CI 0.96〜1.06)，但RA組在RA診斷後5年的死亡率增加(診斷RA 10年後的HR為1.43 (95%CI 1.28-1.59))。考慮到RA病程的影響，研究發現近期診斷的RA患者死亡率沒有明顯更低的趨勢。

結論

盡管RA死亡率在逐漸下降，但RA仍然與死亡風險增加有關。因此，雖然近年來RA管理方麵已取得了進步，我們仍然需要從疾病初發時預防疾病進展和並發症做出更多努力。

原 文

Abstract

OBJECTIVE:To investigate if, and when, patients diagnosed withrheumatoid arthritis(RA) in recent years are at increased risk of death.

METHODS:Using anextensive register linkage, we designed a population-based nationwide cohort study in Sweden. Patients with new-onsetRA from the Swedish Rheumatology Quality Register, and individually matched comparators from the general population were followed with respect to death, as captured by the total population register.

RESULTS:17 512 patients with new-onset RA between 1 January 1997 and 31 December 2014, and 78 847 matched general population comparator subjects were followed from RA diagnosis until death, emigration or 31 December 2015. There was a steady decrease in absolute mortality rates over calendar time, both in the RA cohort and in the general population. Although the relative risk of death in the RA cohort was not increased (HR=1.01, 95% CI 0.96 to 1.06), an excess mortality in the RA cohort was present 5 years after RA diagnosis (HR after 10 years since RA diagnosis=1.43 (95% CI 1.28 to 1.59)), across all calendar periods of RA diagnosis. Taking RA disease duration into account, there was no clear trend towards lower excess mortality for patients diagnosed more recently.

CONCLUSIONS:Despite decreasing mortality rates, RA continues to be linked to an increased risk of death. Thus, despite advancements in RA management during recent years, increased efforts to prevent disease progression and comorbidity, from disease onset, are needed.

引自：Holmqvist M,Ljung L,Askling J, et al. Mortality following new-onsetRheumatoid Arthritis: has modern Rheumatology had an impact?[J]Ann Rheum Dis.2017 Sep 28. pii: annrheumdis-2017-211375. doi: 10. 1136/annrheumdis-2017-211375. [Epub ahead of print]

轉自：中國風濕病公眾論壇

翻譯：北醫三院建磊磊