围绝经期女性类风湿关节炎患者临床特征分析

Clinical characteristics of perimenopausal female patients with rheumatoid arthritis

目的了解女性类风湿关节炎(RA)患者的绝经状态及围绝经期患者临床特征。方法横断面研究。回顾性纳入2015年8月至2023年8月就诊于中山大学孙逸仙纪念医院的女性RA患者,收集其临床资料,包括发病年龄、病程、RA疾病活动、功能及放射学指标和绝经状态等。依绝经状态情况,将患者分为生育期、围绝经期和绝经后期组,分析绝经状态分布及比较3组的临床特征。结果共纳入女性RA患者1151例,年龄为(50.2±13.0)岁,入组时处于生育期患者470例(40.8%)、围绝经期140例(12.2%)和绝经后期541例(47.0%),绝经年龄为(49.0±4.2)岁。与生育期患者相比,围绝经期女性RA患者的疾病活动指标[临床疾病活动指数(CDAI)[M(Q_(1),Q_(3))]:17(6,26)比10(3,19)]、炎症水平[红细胞沉降率(ESR):35(21,65)比26(14,44)mm/1h、C反应蛋白(CRP):6.2(3.2,16.8)比3.3(3.2,13.6)mg/L]和功能受限的比例[25.0%(35/140)比10.4%(49/470)]均更高(均P<0.0167);而与绝经后期患者相比,RA疾病活动指标[CDAI:17(6,26)比14(6,25)分,ESR:35(21,65)比42(23,72)mm/1h、CRP:6.2(3.2,16.8)比6.2(3.3,23.9)mg/L]及功能受限比例[25.0%(35/140)比28.8%(156/541)]相当(均P>0.0167)。围绝经期RA患者中,35.0%(49/140)患者RA为围绝经期发病,与生育期发病患者相比,围绝经期发病的RA患者28个压痛关节数[7(2,10)比4(0,8)个]、CDAI[20(12,29)比14(4,24)]及ESR水平[45(25,72)比32(18,56)mm/1h]均较高(均P<0.05)。结论围绝经期女性RA患者的疾病活动和功能受限均较重。

Objective To explore the menopause status of patients with rheumatoid arthritis(RA)and clinical characteristics of perimenopausal RA patients.Methods A cross-sectional study.Female RA patients were recruited retrospectively in the Sun Yat-Sen Memorial Hospital from August 2015 to August 2023.Clinical data were collected,including onset age,disease duration,RA disease activity indicators,functional assessment,and radiographic scores.According to menopausal status,the patients were categorized as pre-menopausal,perimenopausal and post-menopausal groups to explore their menopausal and clinical characteristics.Results A total of 1151 female patients were enrolled,with a mean age of(50.2±13.0)years.At enrollment,there were 470(40.8%),140(12.2%)and 541(47.0%)patients in pre-menopause,perimenopause and post-menopause status,respectively.The mean age of menopause was(49.0±4.2)years.Compared with pre-menopausal group,perimenopausal RA patients had higher disease activity indicators[clinical disease activity index(CDAI)17(6,26)vs 10(3,19)],higher levels of inflammation[erythrocyte sedimentation rate(ESR)35(21,65)vs 26(14,44)mm/1h,C-reactive protein(CRP)6.2(3.2,16.8)vs 3.3(3.2,13.6)mg/L],and a higher proportion of functional limitation[25.0%(35/140)vs 10.4%(49/470)](all P<0.0167);while there was no significant differences in disease activity[M(Q_(1),Q_(3))][CDAI 17(6,26)vs 14(6,25)],levels of inflammation[ESR 35(21,65)vs 42(23,72)mm/1h,CRP 6.2(3.2,16.8)vs 6.2(3.3,23.9)mg/L]and functional limitation[25.0%(35/140)vs 28.8%(156/541)]when compared with those in post-menopausal group(all P>0.0167).In RA patients during the perimenopausal period,49 cases(35.0%)developed RA during this period.Compared with patients with RA onset during reproductive age,patients with RA onset during the perimenopausal period had higher numbers of 28-joint tender joints[7(2,10)vs 4(0,8)],higher CDAI[20(12,29)vs 14(4,24)],and higher ESR[45(25,72)vs 32(18,56)mm/1h](all P<0.05).Conclusion Perimenopausal patients with RA have severe disease activity and functional limitation.