早期类风湿性关节炎的初始表现
Lauri Weman1, Henri Salo2, Laura Kuusalo3
1University of Eastern Finland and Jyväskylä Central Hospital, Jyväskylä, Finland.
PloS one
|July 6, 2023
概括
血清阴性类风湿性关节炎 (RA) 患者最初的疾病负担较高. 早期诊断,无论ACPA状态如何,都与RA患者的严重疼痛和功能衰退有关.
科学领域:
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
- 临床医学 临床医学
背景情况:
- 类风湿性关节炎 (RA) 是一种慢性自身免疫性疾病,其特征是关节炎症.
- 血清学标记物,如抗素蛋白抗体 (ACPA) 和类风湿因子 (RF),对于RA诊断和分类至关重要.
- 了解与血清状况和症状持续时间相关的初始疾病呈现对于及时管理至关重要.
研究的目的:
- 在初始诊断时调查RA在血清阳性患者和血清阴性患者的临床表现.
- 评估症状持续时间对疾病活动和患者报告的新诊断的RA结果的影响.
- 为了比较ACPA阳性和ACPA阴性RA患者之间的疾病负担.
主要方法:
- 对接受DMARD治疗的1816名新诊断的RA患者的国家注册数据的回顾性分析 (1/2019-9/2021).
- 根据血清状况 (ACPA/RF阳性与阴性) 进行关节计数,对称胀,疾病活性评分 (DAS28) 和患者报告结果 (PROs) 的比较.
- 回归分析评估临床变量与症状持续时间 (<3,3-6个月,>6个月),根据年龄,性别和血清阳性进行调整.
主要成果:
- 与血清阳性患者相比,血清阴性RA患者的疾病活性指标和PRO显著增加,包括胀关节数 (SJC46:10对5) 和DAS28 (4.7对3.7),与血清阳性患者相比 (p<0.001).
- 在3个月内诊断的患者报告疼痛增加 (VAS:62 vs. 52/50) 和功能障碍 (HAQ:1.1 vs. 0.9/0.75) (p<0.001,p=0.002).
- 在诊断症状>6个月后的患者中,ACPA阳性比较频繁 (77%对70%,p=0.045).
结论:
- 最初的RA呈现主要涉及对称关节炎.
- 血清阴性RA患者在诊断时的疾病负担更高.
- 早期的RA诊断与更大的症状严重程度 (疼痛,功能障碍) 相关,无论ACPA状态如何.
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