Thiele Katja, Buttgereit Frank, Huscher Doerte, Zink Angela
German Rheumatism Research Centre, Berlin.
Arthritis Rheum. 2005 Oct 15;53(5):740-7. doi: 10.1002/art.21467.
To describe the current use of glucocorticoids in German patients with rheumatoid arthritis (RA).
We analyzed clinical and patient-derived data from 10,068 outpatients with RA from the national database of the German Collaborative Arthritis Centres for the year 2001 collected by more than 80 rheumatologists in hospitals and private practices.
Systemic glucocorticoid therapy was prescribed for 60% of all patients with RA in rheumatologic care. The proportion of patients receiving systemic glucocorticoids in addition to disease-modifying antirheumatic drug (DMARD) therapy ranged from 53% to 81% of the patients for the various DMARDs. Glucocorticoid therapy was administered more often in combination with tumor necrosis factor inhibitors (81%), cyclosporin A (80%), or leflunomide (77%) than with more traditional DMARDs such as methotrexate (63%) or sulfasalazine (55%). Regarding the prevention and treatment of osteoporosis, 63% of patients taking systemic glucocorticoids were also receiving some type of osteoporosis therapy, as opposed to only 26% of those not taking glucocorticoids.
Glucocorticoids play a pivotal role in the management of RA. This is reflected in the extensive use of low-dose glucocorticoids by German rheumatologists. Even if highly effective DMARDs are prescribed, they are accompanied by glucocorticoids, at least in the initial phase. High-dose glucocorticoids are prescribed for only a small proportion of the patients. There is increasing awareness of the risk of osteoporosis in long-term glucocorticoid treatment, demonstrated by the fact that osteoporosis medication is prescribed for a large proportion of patients taking glucocorticoids.
描述糖皮质激素在德国类风湿关节炎（RA）患者中的当前使用情况。
我们分析了来自德国协作关节炎中心国家数据库的10068例RA门诊患者的临床和患者来源数据，这些数据由80多名医院和私人诊所的风湿病学家于2001年收集。
在风湿病护理中，60%的RA患者接受了全身糖皮质激素治疗。在接受改善病情抗风湿药物（DMARD）治疗的患者中，同时接受全身糖皮质激素治疗的比例因不同DMARD而异，范围为53%至81%。糖皮质激素治疗与肿瘤坏死因子抑制剂（81%）、环孢素A（80%）或来氟米特（77%）联合使用的频率高于与甲氨蝶呤（63%）或柳氮磺胺吡啶（55%）等更传统的DMARD联合使用的频率。关于骨质疏松症的预防和治疗，63%服用全身糖皮质激素的患者也在接受某种类型的骨质疏松症治疗，而未服用糖皮质激素的患者中这一比例仅为26%。
糖皮质激素在RA的管理中起着关键作用。这体现在德国风湿病学家广泛使用低剂量糖皮质激素。即使开具了高效的DMARD，至少在初始阶段，它们也会与糖皮质激素一起使用。只有一小部分患者开具高剂量糖皮质激素。长期糖皮质激素治疗中骨质疏松症风险的认识不断提高，这体现在很大一部分服用糖皮质激素的患者都开具了骨质疏松症药物这一事实上。
