教育水平可影响类风湿关节炎患者的疼痛和关节功能，但对疾病活动度无影响

作者：Xia Jiang 等   翻译：李常虹

发布者：翟佳羽 审校者：李常虹

背景：

在普通税收支持的医疗系统的国家（如瑞典），社会经济学地位低下是否与类风湿关节炎预后结局不好有关仍然值得去探讨。本研究的目的旨在评估教育背景（获得大学文凭（高）或无大学文凭（低））对早期类风湿关节炎预后的影响，分别在疾病活动度、疼痛和功能损害方面进行评估。

方法：

来自EIRA试验的3021例未使用过抗风湿药物治疗的类风湿关节炎患者被纳入本项研究。采用3种方式对预后结局进行分类：1）评分≥中位数VS小于中位数；2）DAS28为基础的低疾病活动度，反应良好和缓解；3）评分下降大于中位数VS小于中位数。采用改良的泊松回归模型分析教育背景与基线时、随访3、6和9个月时疾病结局之间的相关性。

结果：

不同教育背景的患者间具有相似的症状持续时间（195天）和基线时抗风湿治疗策略，以及随访过程中相当的治疗方式。具有高等教育背景的患者在基线时疼痛程度和功能受损更轻，且该现象会持续至整个随访期。治疗1年时，此类患者还更容易达到疼痛的缓解（VAS≤20）。经吸烟和BMI调整后分析仅轻微影响了研究结果。患者教育背景不影响DAS28为基础的疾病活动程度评估。

结论：

在瑞典，接受过高等教育的类风湿关节炎患者疼痛更轻，功能丧失情况更少。此外，此类患者在经过一年的标准治疗以后更容易活动疼痛缓解。重要的是，教育背景不影响患者从发病到就诊风湿科的时间长短、不影响疾病活动度和抗风湿药物的治疗。

附原文：

Introduction: Whether low socioeconomic status (SES) is associated with worse rheumatoidarthritis (RA) outcomes in countries with general tax-financed healthcare systems(such as Sweden) remains to be elucidated. Our aim was to investigate theinfluence of educational background (achieving university/college degree (high)or not (low)) on the outcomes of early RA, in terms of disease activity(DAS28), pain (VAS-pain), and functional impairment (HAQ).Methods: We evaluatedDMARD-na?ve RA patients recruited in the Epidemiological Investigation of RA(EIRA) study with outcomes followed in the Swedish Rheumatology Quality (SRQ)register (N=3021). Outcomeswere categorized in three ways: 1) scores equal to/above median vs. belowmedian; 2) DAS28-based low disease activity, good response, remission; 3)scores decreased over the median vs. less than median. Associations betweeneducational background and outcomes were calculated by modified Poissonregressions, at diagnosis and at each of the three standard (3, 6, 12 months)follow-up visits.Results: Patients with different educational background hadsimilar symptom durations (195 days) and anti-rheumatic therapies at baseline,and comparable treatment patterns during follow-up. Patients with a higheducation level had significantly less pain and less functional disability atbaseline and throughout the whole follow-up period (VAS-pain: baseline: 49(28-67) vs. 53 (33-71), p<0.0001;1-year visit:>=0.81 (95 % CI0.73-0.90). HAQ: baseline: 0.88 (0.50-1.38) vs. 1.00 (0.63-1.50), p=0.001;1-year visit: 0.84 (0.77-0.92)). They also had greater chances to achievepain remission (VAS-pain≤20) after one year(1.17 (1.07-1.28)). Adjustments for smoking and BMI altered the results onlymarginally. Educational background did not influence DAS28-basedoutcomes.Conclusion: In Sweden, with tax-financed, generally accessiblehealthcare system, RA patients with a high education level experienced lesspain and less functional disability. Further, these patients achieved painremission more often during the first year receiving standard care.Importantly, education background affected neither time to referral torheumatologists, disease activity nor anti-rheumatic treatments.

引自：

Xia Jiang,Maria E. C. Sandberg, Saedis Saevarsdottir,et al.Highereducation is associated with a better rheumatoid arthritis outcome concerningfor pain and function but not disease activity: results from the EIRA cohortand Swedish rheumatology register. Arthritis Research &Therapy201517:317,DOI: 10.1186/s13075-015-0836-6.