Predictors of survival in a cohort of patients with polymyositis and dermatomyositis effect of corticosteroids, methotrexate and azathioprine 英文参考文献.docVIP

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Predictors of survival in a cohort of patients with polymyositis and dermatomyositis effect of corticosteroids, methotrexate and azathioprine 英文参考文献.doc

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Predictors of survival in a cohort of patients with polymyositis and dermatomyositis effect of corticosteroids, methotrexate and azathioprine 英文参考文献

Schiopuetal.ArthritisResearchTherapy2012,14:R22 /content/14/1/R22 RESEARCH ARTICLE OpenAccess Predictorsofsurvivalinacohortofpatientswith polymyositisanddermatomyositis:effectof corticosteroids,methotrexateandazathioprine ElenaSchiopu1,KristinePhillips1,PaulMMacDonald2,LeslieJCrofford3andEmilyCSomers1* Abstract Introduction:Theidiopathicinflammatorymyopathiesarerarediseasesforwhichdataregardingthenatural history,responsetotherapiesandfactorsaffectingmortalityareneeded.Weperformedthisstudytoexaminethe effectsoftreatmentandclinicalfeaturesonsurvivalinpolymyositisanddermatomyositispatients. Methods:Atotalof160consecutivepatients(77withpolymyositisand83withdermatomyositis)seenatthe UniversityofMichiganfrom1997to2003wereincluded.Medicalrecordswereabstractedforclinical,laboratory andtherapeuticdata,includinginitialsteroidregimenandimmunosuppressiveuse.Statevitalrecordswereutilized toderivemortalityandcauseofdeathdata.Survivalwasmodeledbyleft-truncatedKaplan-Meierestimationand Coxregression. Results:The5-and10-yearsurvivalestimateswere77%(95%CI=66to85),and62%(95%CI=48to73), respectively,andtheratesweresimilarforpolymyositisanddermatomyositis.Survivalbetweenthesexeswas similarthrough5yearsandsignificantlylowerthereafterformales(10-yearsurvival:18%male,73%female;P= 0.002for5-to10-yearinterval).Thesexdisparitywasrestrictedtothepolymyositisgroup.Increasedageat diagnosisandnon-Caucasianracewereassociatedwithlowersurvival.Intravenousversusoralcorticosteroiduse wasassociatedwithahigherriskofdeathamongCaucasians(HR=10.6,95%CI=2.1to52.8).Earlysurvival betweenpatientstreatedwithmethotrexateversusazathioprinewassimilar,butsurvivalat10yearswashigherfor themethotrexate-treatedgroup(76%vs52%,P=0.046for5-to10-yearinterval). Conclusions:Patientstreatedinitiallywithintravenouscorticosteroidshadhighermortality,whichwaslikely relatedtodiseaseseverity.Bothmethotrexateandazathioprineshowedsimilarearlysurvivalbenefitsasfirst-line immunosuppressivedrugs.Survivalwashigherbetween5and10yearsinth