病情高度活动的RA病人的感染风险增加

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Ann Rheum Dis 2011;70:785-791 doi:10.1136/ard.2010.128637 High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis 1.       Karen Au1, 2.       George Reed2, 3.       Jeffrey R Curtis3, 4.       Joel M Kremer4, 5.       Jeffrey D Greenberg5, 6.       Vibeke Strand6, 7.       Daniel E Furst1 on behalf of the CORRONA Investigators Abstract Objective To determine the relationship of disease activity to infections in patients with rheumatoid arthritis (RA). Methods From the CORRONA database, the incidence of physician-reported infections in RA patients on stable disease-modifying antirheumatic drug, biological, and corticosteroid therapy for at least 6 months was ascertained. Two composite measures of disease activity were defined: clinical disease activity index (CDAI) and disease activity score 28 (DAS28). Incident rate ratios (IRR) were calculated using generalised estimating equation Poisson regression models adjusted for demographics, medications and clinical factors. Results Of 1 6242 RA patients, 6242 were on stable therapy for at least 6 months and were eligible for analysis. 2282 infections were reported in the cohort, followed over 7290 patient-years. After controlling for possible confounders, disease activity was associated with an increased rate of infections. Each 0.6 unit increase in DAS28 score corresponded to a 4% increased rate of outpatient infections (IRR 1.04, p=0.01) and a 25% increased rate of infections requiring hospitalisation (IRR 1.25, p=0.03). There was a dichotomy in the relationship between infections and CDAI scores. For CDAI <10 (mild disease activity) patients had a 12% increased rate of outpatient infections with each 5 unit increase in CDAI score (IRR 1.12, p=0.003). At CDAI scores ≥10, there was no further increase in the rate of outpatient infections associated with higher disease activity. The relationship of CDAI to hospitalised infections showed similar trends to outpatient data but did not reach statistical significance after multivariate analysis (CDAI <10: IRR 1.56, p=0.08). Conclusions In this large cohort of RA patients, higher disease activity was associated with a higher probability of developing infections.

病情高度活动的RA病人的感染风险增加 Au K, et al. Ann Rheum Dis. 2011;70:785-791   目的: 确定类风湿关节炎（RA）患者的疾病活动度与感染风险的相关性。 方法: 基于CORRONA数据库的信息，本研究核实了由医生报告的RA病人感染发生情况，这些病人接受稳定剂量的改善病情抗风湿药物(DMARDs)、生物制剂和糖皮质激素治疗且疗程至少6个月。本研究采纳两种复合性指标，CDAI和DAS28，用于评估疾病活动度。本研究利用广义估计方程泊松回归模型，在人口统计学、药物和其它临床因素之后，计算发生率比值(IRR, 率比)。 结果: 16242名RA患者中，接受稳定剂量药物治疗≥6个月的6242例适合本研究分析。在随访总计7290病人年期间，该队列共有2282起感染报告。在控制可能混杂因素之后，分析提示RA病情活动是与感染率增加相关联。DAS28评分每增加0.6单位，则门诊感染报告率增加4%(IRR: 1.25，p = 0.03）。CDAI分值有两个区段，有不同的感染风险。CDAI分值<10 (低度活动) 的病人，CDAI分值每 5单位则门诊感染报告率增加12% (IRR: 1.12，p = 0.003）。CDAI分值≥10的病人中，门诊感染报告率并不随疾病活动度增加而增加。多元分析显示，CDAI与院内感染报告率的相关性也有相似的趋势，但未达统计学显著意义（CDAI < 10: IRR = 1.56, p = 0.08)。 结论: 在这个大型RA队列中，本研究发现病情高活动者的感染风险增加。