老年和青年类风湿关节炎患者发病特点及治疗对比研究

被引：29

作者：

王舒婷 ^{[1
,2
]}

刘坚 ^{[3
]}

韦嵩 ^{[1
]}

机构：

[1] 广州军区广州总医院中医科

[2] 广州中医药大学博士研究生

[3] 广州军区广州总医院老年病科

来源：

中华老年医学杂志 | 2017年 / 06期

关键词：

老年类风湿关节炎; 发病特点;

D O I：

暂无

中图分类号：

R593.22 [类风湿性关节炎];

学科分类号：

100201 [内科学];

摘要：

目的比较老年类风湿关节炎(EORA)与青中年类风湿关节炎(YORA)的临床特点与治疗策略。方法 150例类风湿关节炎以发病年龄≥60岁为界分为EORA组和YORA组, 分析比较两组患者性别比、病情活动度、疾病严重程度、关节外表现、并发症情况、实验室指标以及治疗方案。结果 EORA组男女比例24/36(1.0∶1.5), YORA组21/69(1.0∶3.3), EORA组患者关节晨僵、近端指间关节和掌指关节受累分别为53.3%、46.7%和61.7%低于YORA72.2%、77.8%、81.1%(χ2=5.521、15.385、6.960, P=0.018、0.000、0.008);大关节为始发关节为38.3%, 高于YORA组18.9%(χ2=6.960, P=0.008);EORA组患者关节肿胀数和压痛数分别为(16.5±7.3)个和(15.9±8.4)个, 少于YORA组(22.5±7.6)个和(23.8±8.9)个(t=5.080、5.740, 均P=0.000);在疾病活动性评估方面, EORA组患者DAS28评分为(5.9±1.6)分, 高于YORA组(4.9±1.6)分, (t=3.360, P=0.001), HAQ量表评分为(0.8±0.9)分, 低于YORA组(1.2±0.9)分(t=2.430, P=0.02)。EORA组的骨性关节炎、骨质疏松症、心血管疾病和慢性肾功能不全并发症为51.7%、31.7%、18.3%、15.0%, 高于YORA组27.8%、15.6%、5.6%和4.4%, (χ2=11.722、5.445、6.168、5.067, P=0.001、0.020、0.013、0.024);EORA组患者RF阳性率为48.3%, 低于YORA组70.0%(χ2=7.126, P=0.008);治疗上, EORA组接受糖皮质激素治疗比例38.3%, 较YORA20.0%高(χ2=6.092, P=0.014), 而抗风湿药物(DMARDs)和生物制剂的使用40.0%和10.0%低于YORA组78.9%和31.1%(χ2=14.940、9.153, P=0.000、0.002)。结论 EORA患者男女比例趋向平衡, 临床发病不典型, 血清学阴性率高, 特异性抗体阳性率低, 易导致早期诊断困难。合并疾病允许的情况下, 建议EORA患者应密切结合病情积极选择DMARDs药物治疗。

引用

共 7 条

[1]

Two-year results of disease activity score (DAS)-remission-steered treatment strategies aiming at drug-free remission in early arthritis patients (the IMPROVED-study)[J] Heimans Lotte;Akdemir Gülşah;Boer Kirsten V C Weversde;GoekoopRuiterman Yvonne P;Molenaar Esmeralda T;van Groenendael Johannes H L M;Peeters Andreas J;SteupBeekman Gerda M;Lard Leroy R;de Sonnaville Peter B J;Grillet Bernard A M;Huizinga Tom W J;Allaart Cornelia F Arthritis Research & Therapy 2016,

[2]

Comparative study of elderly-onset rheumatoid arthritis and young-onset rheumatoid arthritis in a Colombian population: clinical; laboratory and HLA-DRB1 findings.[J] Spinel-Bejarano Néstor;Quintana Gerardo;Heredia Rodrigo;Yunis Juan José;Caminos Jorge E;Garcés Maria F;Rondon Federico;Iglesias-Gamarra Antonio Clinical and experimental rheumatology 2013,

[3]

2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative[J] Arthritis & Rheumatism 2010,

[4]

Guidelines for the use of conventional and newer disease-modifying antirheumatic drugs in elderly patients with rheumatoid arthritis.[J] Díaz-Borjón Alejandro Drugs & aging 2009,

[5]

Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA; an open-label strategy trial).[J] Verstappen S M M;Jacobs J W G;van der Veen M J;Heurkens A H M;Schenk Y;ter Borg E J;Blaauw A A M;Bijlsma J W J Annals of the rheumatic diseases 2007,

[6]

Gouty Arthritis Mimicking Rheumatoid Arthritis[J] Kelly L. Cobb;Enrique A. Mendez;Luis R. Espinoza JCR: Journal of Clinical Rheumatology 1998,

[7]

EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Peters M J L;Symmons D P M;McCarey D;Dijkmans B A C;Nicola P;Kvien T K;McInnes I B;Haentzschel H;Gonzalez-Gay M A;Provan S;Semb A;Sidiropoulos P;Kitas G;Smulders Y M;Soubrier M;Szekanecz Z;Sattar N;Nurmohamed M T Annals of the rheumatic diseases 2010,

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