类风湿关节炎患者功能受限特征及相关因素分析

The characteristics and associated factors of functional limitation in patients with rheumatoid arthritis

目的探讨类风湿关节炎(RA)患者功能受限的临床特征及其相关因素。方法纳入2015年8月至2019年6月就诊于中山大学孙逸仙纪念医院风湿免疫科的RA患者,收集其人口学特征和临床资料,包括年龄、性别、红细胞沉降率、疼痛视觉模拟评分、功能受限程度、临床疾病活动指数、改良Sharp评分总分等。采用斯坦福健康评估问卷残疾指数(HAQ-DI)评估身体功能,包括穿衣与修饰、起身、进食、步行、个人卫生、取物、紧握和活动8个特征。采用有序logistic回归分析功能受限的相关因素。结果共纳入643例RA患者,男性114例,女性529例,年龄(49.7±12.9)岁,其中399例(62.1%)存在不同程度的功能受限,293例(45.6%)为轻度,73例(11.4%)为中度,33例(5.1%)为重度。功能受限的患者比例随年龄(从16~39岁的51.8%升至≥60岁的73.3%)、疾病活动度(从RA疾病缓解期的15.3%升至高疾病活动度的96.3%)的升高而增加,与病程呈U形曲线关系。功能受限最常见的特征是步行[43.5%(280/643)],其次为紧握[36.1%(232/643)]、取物[35.5%(228/643)]、活动[33.4%(215/643)]、个人卫生[33.0%(212/643)]、穿衣与修饰[29.7%(191/643)]、起身[29.1%(187/643)],进食受限最少见[18.4%(118/643)]。多因素有序logistic回归分析显示,年龄(OR=1.019,95%CI 1.004~1.035)、疼痛视觉模拟评分(OR=1.820,95%CI 1.616~2.050)、红细胞沉降率(OR=1.009,95%CI 1.001~1.017)、临床疾病活动指数(OR=1.080,95%CI 1.059~1.102)和改良Sharp评分总分(OR=1.010,95%CI 1.004~1.015)是RA患者功能受限的独立相关因素。结论大多数RA患者存在不同程度的功能受限,尤其是步行受限最常见,且与年龄、疼痛、疾病活动相关,提示应重视RA患者疼痛的管理及控制疾病活动性的达标治疗。

Objective To investigate the characteristics of functional limitation and associated factors in patients with rheumatoid arthritis(RA).Methods Consecutive patients with RA were recruited from August 2015 to June 2019 at Department of Rheumatology,Sun Yat-Sen Memorial Hospital.Demographic and clinical characteristics including age,gender,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)of pain,clinical disease activity index(CDAI),modified total Sharp score were collected.Physical function was assessed by the Stanford health assessment questionnaire disability index(HAQ-DI).Ordered logistic regression was used to analyze the related factors of HAQ-DI.Results A total of 643 RA patients were finally recruited including 114 males and 529 females with mean age(49.7±12.9)years.There were 399(62.1%)patients having different degrees of functional limitation,who were classified as mild(293,45.6%),moderate(73,11.4%)and severe(33,5.1%).The prevalence of functional limitation was positively correlated with age and disease activity.The most restricted activity was walking[43.5%(280/643)],followed by gripping[36.1%(232/643)],reaching[35.5%(228/643)],daily activities[33.4%(215/643)],hygiene[33.0%(212/643)],dressing and grooming[29.7%(191/643)]and arising[29.1%(187/643)],and the last eating[18.4%(118/643)].Multivariate ordered logistic regression analysis showed that age(OR=1.019,95%CI 1.004-1.035),pain VAS(OR=1.820,95%CI 1.616-2.050),ESR(OR=1.009,95%CI 1.001-1.017),CDAI(OR=1.080,95%CI 1.059-1.102)and modified total Sharp score(OR=1.010,95%CI 1.004-1.015)were associated factors of functional limitation.Conclusion The majority RA patients have functional limitation.Age,pain and active disease are independent associated factors.Therefore,target treatment and control of pain should be emphasized in RA patients.