类风湿性关节炎的第一次骨折:根据骨折部位,性别,年龄和并发症进行分析
Owen Taylor-Williams1,2, Helen Keen3,4, David B Preen5
1Rheumatology Group, Medical School, University of Western Australia, Perth, Australia. Owen.Taylor-Williams@research.uwa.edu.au.
概括
类风湿性关节炎 (RA) 患者的骨折风险增加了32%,包括严重的骨质疏松性骨折. 即使在RA诊断之前,骨折风险也会增加,这凸显了早期预防策略的必要性.
科学领域:
- 骨质免疫学 骨质免疫学
- 类风湿病学 类风湿病学
- 流行病学 流行病学
背景情况:
- 类风湿性关节炎 (RA) 是一种骨质免疫学疾病,与骨质疏松症,脆弱性骨折 (FF) 和主要骨质疏松性骨折 (MOF) 的风险增加有关.
- 有限的研究已经全面评估了RA骨折风险概况,特别是考虑到统计匹配,并发症和非MOF地点.
研究的目的:
- 为了比较第一FF,MOF和非MOF在RA患者中的发病率与匹配的对照队列.
- 为了在RA患者和对照人群之间的骨折发病率比较中进行并发症调整.
主要方法:
- 使用西澳大利亚风湿病流行病学登记处 (WARDER) (1980-2015) 的行政数据进行了纵向队列研究.
- 使用国际疾病分类 (ICD) 代码识别了RA患者,并与没有风湿病的住院患者进行了比较.
- 进行病例对照匹配,根据年龄,性别和查尔森并发症指数进行调整. 计算了95%置信区间 (CI) 的发病率 (IR) 和发病率比率 (IRR).
主要成果:
- 经调整后,RA患者的第一次骨折发生率增加了32% (IRR为1.32,95% CI为1.10-1.60).
- 对于MOF (IRR1.44,95% CI 1.19-1.86) 和非MOF地点,观察到发病率增加.
- 在第一个记录的RA医院诊断前大约6年,骨折发生率明显更高 (RR 1.58,CI 1.05-2.39).
结论:
- 即使调整了关键的人口和临床因素,RA也与首次骨折的发生率显著更高,包括MOF.
- 在RA患者中,骨折风险增加的时间早于他们首次被诊断,这表明潜在的疾病过程有助于骨脆弱.
- 早期和全面的骨折预防策略对于RA患者至关重要.
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