全国多中心类风湿关节炎患者残疾及功能受限情况的调查

A multicenter study of deformity and disabmty in rheumatoid arthritis patients in China

目的了解类风湿关节炎（RA）患者的残疾及功能受限情况，分析RA导致残疾及功能受限的影响因素。方法应用问卷方式回顾性调查340例RA患者的残疾情况，应用健康评定量表残疾指数（HAQ．DI）评价患者功能受限情况。采用SPSS13．0软件对残疾及HAQ．DI的影响因素进行单因素及多因素Logistic多元回归分析。结果①根据3种不同的标准，RA患者中残疾的发生率分别为50．3％（171／340）、36．8％（125／340）及18．8％（64／340），且均随病程的延长而增加。最常见的受累关节依次为腕关节（111／340，32．6％）、近端指间关节（82／340，24．1％〉及肘关节（69／340，20．3％）。对影响残疾的因素进行Logistic多元回归分析，结果显示女性[比值比（DR）=5．179，95％可信区间（CI）：1．593～16．836，P=0．006]、病程较长（OR=1．104，95％CI：1．065-1．146，P=0．ooo）、存在关节外表现（OR=3．813，95％CI：1．814-8．011，P=0．000）及医生可视模拟评分（VAS）疾病活动评分较高（OR=1．392，95％CI：1．230-1．577，P=0．000）是RA患者发生残疾的独立危险因素（P〈0．05，R2=0．345）。②RA患者中68．5％（233／340）存在不同程度的功能受限，其中31．3％（120／340）存在轻度功能受限，19．7％（67／340）中度功能受限，13．5％（461340）重度功能受限。Logistic多元回归分析结果提示年龄较大（DR=1．028，95％CI：1．012-1．046，P=0．001）、医生VAS疾病活动评分较高（OR=1．603，95％Ch1．311-1．958，P=0．000）及从未规律应用过改善病情抗风湿药（DMARD8）（OR=1．721，95％CI：1．054～2．809，P=0．030）是导致患者功能受限的独立危险因素（P〈0．05，RZ=0．384）。结论RA患者残疾及功能受限发生率高，且随病程延长而增加。高龄、女性、病程较长、存在关节外表现、医生疾病活动VAS评分较高及从未规律应用过DMARDs是导致RA患者残疾和（或）功能受限的独立危险因素。

Objective To describe the condition of deformity and disability in rheumatoid arthritis patients in China, and to analyze the factors that may affect deformity and disability. Methods Data were obtained from a cross-section survey of 340 patients with rheumatoid arthritis （RA）, selected from Department of Rheumatology in 21 general hospitals across China. Demographic data, clinical data and Stanford health assessment questionnaire disability index （HAQ-DI） scores were collected. Univariate analysis and Logistic multiple regression were performed to determine independent prognostic factors of deformity and disability. Results ① Occurrence of deformity differed by three different standards [50.3% （171/340）, 36.8% （125/340） and 18.8%（64/340） respectively], and increased with the disease course in rheumatoid arthritis patients. The most common joints involved were wrist （111/340, 32.6% ）, proximal interphalangeal joint （82/340, 24.1% ） and elbow （69/340, 20.3% ）. Multiple regression analysis showed that female gender （0R=5.179, 95%CI： 1.593-16.836, P=0.006）, long disease course （OR=1.104, 95%CI： 1.065-1.146, P=0.000）, presence of extra-artieular manifestations （0R=3.813, 95%CI： 1.814-8.011, P=0.000）and high physieian VAS disease activity score （0R=1.392, 95%CI： 1.230-1.577, P=0.000） were independent risk factors for deformity （P〈0.05）. ② The median HAQ-DI score for rheumatoid arthritis patients was 0.500 points （interquartile range, 0 to 1.250）. Ordinal Logistic regression showed that elder （0R=1.028, 95%CI： 1.012-1.046, P=0.001）, higher physician VAS disease activity score （0R=1.603, 95%CI： 1.311-1.958, P=0.000） and never used disease-modifying antirheumatic drugs （DMARDs） regularly （0R=1.721, 95%CI： 1.054-2.809, P=0.030） eould predict severe disability independently （P〈0.05）. Conclusion Rheumatoid arthritis patients are at high risk of deformity and disability. Deformity is associated with female gender, long disease course, presence of extra-articular manifestations and high physician VAS disease aetivity score. Disability could be predicted by elder, high physician VAS disease activity score and never used DMARDs regularly.