目的

        我们研究的目的是调查近年来确诊为类风湿关节炎(RA)的患者是否以及何时出现死亡风险增加。

        方法

        通过大量登记联系的方式，我们设计了一项关于瑞典人口的全国性队列研究。来自瑞典风湿病学质量登记册的初发RA患者以及匹配的一般对照人群根据登记的总人口记录死亡率。

        结果

        从1997年1月1日至2014年12月31日期间，有17 512例初发RA患者，以及78 847例匹配的一般对照人群，从诊断RA开始随访至死亡、移民或2015年12月31日为止。在RA队列和一般人群中，随着时间推移，绝对死亡率稳步下降。在RA诊断后的所有时期，RA组的死亡相对危险度无增加(HR = 1.01,95%CI 0.96〜1.06)，但RA组在RA诊断后5年的死亡率增加(诊断RA 10年后的HR为1.43 (95%CI 1.28-1.59))。考虑到RA病程的影响，研究发现近期诊断的RA患者死亡率没有明显更低的趋势。

        结论

        尽管RA死亡率在逐渐下降，但RA仍然与死亡风险增加有关。因此，虽然近年来RA管理方面已取得了进步，我们仍然需要从疾病初发时预防疾病进展和并发症做出更多努力。

        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]

        转自：中国风湿病公众论坛

        翻译：北医三院建磊磊