Department of Rheumatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Scand J Rheumatol. 2011 May;40(3):161-8. doi: 10.3109/03009742.2010.523012. Epub 2010 Nov 16.
To determine whether low-dose prednisolone affects body composition and bone mineral density (BMD) in patients with rheumatoid arthritis (RA), also considering inflammation and physical disability.
This cross-sectional study included 100 patients (50 women) with RA with a median (IQR) disease duration of 8 (4-15) years. Fifty patients had been treated with prednisolone (5-7.5 mg) for at least 2 years (the P-group) and 50 patients matched for gender and age had not (the NoP-group). Body composition and BMD were assessed by dual-energy X-ray absorptiometry (DXA). Disease activity (28-joint Disease Activity Score, DAS28) and physical disability (Health Assessment Questionnaire, HAQ) were assessed.
The total patient group had increased fat mass (FM) and a high trunk:peripheral fat ratio, of which 38% had a fat free mass index (FFMI, kg/m²) below the 10th percentile of a reference population. The P-group had significantly higher FM but similar lean body mass (LBM) and BMD compared with the NoP-group. In multivariate analyses, treatment with prednisolone and a higher HAQ score were significantly and independently associated with higher FM but not with LBM. Higher C-reactive protein (CRP) was independently associated with lower LBM. Higher HAQ score and low weight were significantly and independently associated with lower BMD at femoral neck and lumbar spine.
RA patients treated with low-dose prednisolone had significantly higher FM than patients without prednisolone, an effect that was independent of current inflammation. However, there was no association between prednisolone treatment and muscle mass or BMD. Thus, the net effect of prednisolone on body composition and bone is different in inflammatory diseases such as RA.
确定小剂量泼尼松龙是否会影响类风湿关节炎（RA）患者的身体成分和骨密度（BMD），同时考虑炎症和身体残疾。
本横断面研究纳入了 100 名（50 名女性）RA 患者，中位（IQR）病程为 8（4-15）年。50 名患者接受泼尼松龙（5-7.5mg）治疗至少 2 年（P 组），50 名性别和年龄匹配的患者未接受治疗（NoP 组）。采用双能 X 射线吸收法（DXA）评估身体成分和 BMD。评估疾病活动度（28 关节疾病活动评分，DAS28）和身体残疾（健康评估问卷，HAQ）。
总患者组的脂肪量（FM）增加，躯干：外周脂肪比高，其中 38%的人体脂肪质量指数（FFMI，kg/m²）低于参考人群的第 10 百分位。P 组的 FM 明显较高，但与 NoP 组相比，瘦体重（LBM）和 BMD 相似。多变量分析表明，泼尼松龙治疗和较高的 HAQ 评分与较高的 FM 显著相关，但与 LBM 无关。较高的 C 反应蛋白（CRP）与较低的 LBM 独立相关。较高的 HAQ 评分和低体重与股骨颈和腰椎 BMD 显著且独立相关。
接受小剂量泼尼松龙治疗的 RA 患者的 FM 明显高于未接受泼尼松龙治疗的患者，这种影响独立于当前炎症。然而，泼尼松龙治疗与肌肉质量或 BMD 之间没有关联。因此，泼尼松龙对炎症性疾病（如 RA）的身体成分和骨骼的净影响不同。
