不同发病年龄类风湿关节炎患者的临床特征与治疗

Clinical characteristics and treatment of rheumatoid arthritis in patients with different ages of onset

目的分析不同发病年龄类风湿关节炎(RA)患者的临床特征与治疗。方法RA患者278例分为EORA组(发病年龄≥65岁老年RA患者,75例)、NEORA组(发病年龄<65岁老年RA患者,61例)和YORA组(青壮年发病RA患者,142例)。比较三组临床特征、实验室检查及治疗等情况。结果与YORA组比较,EORA组男性比例增高,压痛关节数和肿胀关节数增多,而病程缩短,抗环瓜氨酸肽抗体阳性率降低(P<0.05或P<0.01),NEORA组病程增加且肿胀关节数增多(P<0.01)。与YORA组比较,EORA组28个关节疾病活动度评分、高活动度比例、CRP、ESR、IL-6、WBC和Plt增高(P<0.05或P<0.01),NEORA组高活动度比例增高(P<0.05)。与YORA组比较,EORA组和NEORA组合并冠心病、高血压、间质性肺炎比例增高,且醋酸泼尼松和雷公藤使用率增加(P<0.05或P<0.01)。结论与青壮年发病RA患者相比,老年发病的RA患者病程短,男性比例和炎症因子水平升高,老年RA患者无论是发病年龄≥65岁或<65岁疾病活动度高且合并症较多,激素使用率高。

Objective To analyze the clinical characteristics and treatment of rheumatoid arthritis(RA)in the patients with different ages of onset.Methods A total of 278 patients with RA were divided into three groups of EORA(elderly RA cases with the onset age of≥65 years old,75 cases),NEORA(elderly RA cases with the onset age of<65 years old,61 cases)and YORA(young RA cases with younger age of onset,142 cases).The clinical characteristics,laboratory examinations and treatments of three groups were compared.Results Compared with group YORA,the percentage of male,swollen joint count and tender joint count were increased,but ACPA positive rate and course of disease were reduced in group EORA(P<0.05 or P<0.01),course of disease and swollen joint count were increased in group NEORA(P<0.01).Compared with group YORA,disease activity score of 28 joints,proportion of high activity,CRP,ESR,IL-6,WBC and Plt were increased in group EORA(P<0.05 or P<0.01),and the proportion of high activity was also increased in group NEORA(P<0.05).Compared with group YORA,the proportions of the patients complicated with coronary heart disease,hypertension and interstitial pneumonia were higher,and usage rates of prednisone acetate and Tripterygium wilfordii were higher in group EORA and group NEORA(P<0.05 or P<0.01).Conclusion Compared with young RA patients,the elderly RA patients with the onset age of≥65 years have shorter course of disease,higher proportion of males and increased level of inflammatory factors,and the elderly RA patients either with the onset age of≥65 years or<65 years old have higher disease activity,with more complications and higher usage rate of hormones.