老年起病类风湿关节炎临床特点分析

Clinical analysis of elderly-onset rheumatoid arthritis

目的探讨老年起病类风湿关节炎(EORA)病人的临床特征。方法选择2018年1月至2019年1月在新疆维吾尔自治区人民医院风湿免疫科初治的类风湿关节炎病人147例,根据病人的起病年龄分为青年起病类风湿关节炎(YORA)组83例和EORA组64例。收集并分析2组病人的临床资料及治疗方案。结果2组性别比例、病程、BMI差异均无统计学意义(P>0.05)。与YORA组相比,EORA组的掌指+近指关节起病人数比例显著减少,膝关节起病人数比例显著增加;WBC、CRP、血沉(ESR)、IL-6、TC水平及类风湿关节炎疾病活动度评分(DAS28-ESR)明显升高;合并高血压、CHD、骨关节炎、骨质疏松、间质性肺炎的病人比例显著增加;强的松、雷公藤的使用率显著增加,生物制剂的使用率显著降低,以上差异均有统计学意义(P<0.05)。结论EORA病人临床发病不典型,疾病活动度高,合并症多,应结合病情积极选择相应的药物治疗,从而延缓疾病进展或降低疾病活动度。

Objective To investigate the clinical characteristics of elderly-onset rheumatoid arthritis(EORA).Methods A total of 147 patients with rheumatoid arthritis in the Department of Rheumatology and Immunology in People's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to January 2019 were enrolled.The clinical data and treatment plans of the patients were collected and analyzed.Results There were no significant differences in sex ratio,course of disease and BMI between the two groups(P>0.05).Compared with youth-onset rheumatoid arthritis(YORA)group,the proportion of the patients with metacarpophalangeal joint and proximal phalangeal joint in EORA group was significantly lower,while that of knee joint was significantly higher;The levels of white blood cell,C-reaction protein,erythrocyte sedimentation rate(ESR),interleukin-6 and total cholesterol,and the DAS28-ESR score were significantly higher in EORA group;The incidence rate of hypertension,coronary heart disease,osteoarthritis,osteoporosis and interstitial pneumonia were significantly higher in EORA group;The utilization rate of prednisone and Tripterygium wilfordii increased significantly,while the utilization rate of biologics decreased significantly in EORA group,and the differences were statistically significant(P<0.05).Conclusions The clinical characteristics of EORA are atypical,but the disease activity is high,and there are many complications.It is important to choose the corresponding drug therapy according to the disease condition,so as to delay the disease progression or reduce the disease activity.