研究背景

        银屑病性关节炎(PsA)是一种慢性炎症性进展性关节炎，可能导致患者严重残疾、生活质量下降和不能继续工作。据报道，PsA影响10%至40%的银屑病患者。在大多数患者中，PsA在银屑病发病之后出现或同时发生。而且，PsA患者常常患有多种合并症，导致发病率和死亡率的增加。

        已知葡萄膜炎和炎性肠病(IBD)与脊柱关节炎密切相关。但是，目前关于PsA患者葡萄膜炎和IBD的患病率、发病率的资料有限，为了阐明PsA与葡萄膜炎和IBD的关系，Charlton R等学者做了以下研究。

        研究目的

        与普通人群和银屑病患者相比，确定银屑病关节炎(PsA)患者发生葡萄膜炎和炎性肠病(IBD)的风险。

        研究方法

        使用英国临床实践研究数据库1998年至2014年的数据进行队列研究。确认18-89岁患有PsA的患者并将其与不发生PsA的银屑病患者队列和一般人群队列进行匹配。计算每个研究队列的葡萄膜炎、所有IBD、克罗恩病和溃疡性结肠炎的发生率，并使用条件泊松回归计算调整的相对风险(RRadj)。

        研究结果

        确认有6783个PsA病例，患者的年龄中位数为49岁。PsA队列中发生葡萄膜炎的风险明显高于普通人群和银屑病队列(RRadj 3.55, 95%CI 2.21-5.70和RRadj 2.13, 95%CI 1.40-3.24)。同时观察到与其他两个队列相比，PsA队列克罗恩病的发病显着增加(RRadj 2.96, 95%CI 1.46-6.00和RR 3.67-0.95, 95%CI 1.83-7.10)，但溃疡性结肠炎的发病无明显差异(RRadj1.30, 95%CI 0.66-2.56和RRadj 0.98，95%CI 0.50-1.92)。

        研究结论

        与普通人群和银屑病对照组相比，基于初始诊疗记录的PsA患者的发病队列发生葡萄膜炎和/或克罗恩病的风险较大，但发生溃疡性结肠炎的风险无明显差异。

        原 文

        Risk of uveitis and inflammatory bowel disease in people with psoriatic arthritis: a population-based cohort study.

        Abstract

        OBJECTIVES:To determine the risk of uveitis and inflammatory bowel disease (IBD) in patients with psoriatic arthritis (PsA) compared with the general population and patients with psoriasis.

        METHODS:A cohort study using data from the UK Clinical Practice Research Datalink between 1998 and 2014. Patients with incident PsA aged 18-89 years were identified and matched to a cohort of patients with psoriasis and a general population cohort. The incidence of uveitis, all IBD, Crohn's disease and ulcerative colitis was calculated for each study cohort and adjusted relative risks (RRadj) were calculated using conditional Poisson regression.

        RESULTS:6783 incident cases of PsA were identified with a median age of 49 years. The risk of uveitis was significantly higher in the PsA cohort than in the general population and psoriasis cohorts (RRadj3.55, 95% CI 2.21 to 5.70 and RRadj2.13, 95% CI 1.40 to 3.24, respectively). A significant increase was observed for Crohn's disease (RRadj2.96, 95% CI 1.46 to 6.00 and RRadj3.60, 95% CI 1.83 to 7.10) but not for ulcerative colitis (RRadj1.30, 95% CI 0.66 to 2.56 and RRadj0.98, 95% CI 0.50 to 1.92).

        CONCLUSIONS:In a primary care-based incidence cohort of patients with PsA, there were substantial risks of developing uveitis and/or Crohn's disease, but not ulcerative colitis, when compared with the general population and psoriasis controls.

        © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

        KEYWORDS:arthritis; epidemiology; psoriatic arthritis

        来源：广东省第二人民医院风湿免疫科

        作者：李天旺 钟正 内容编辑：黄启当

        审核：广东省二医风湿免疫微信工作组