St Joseph's Health Care, 268 Grosvenor St., London, Ontario, Canada.
Rheumatology (Oxford). 2012 Sep;51(9):1662-9. doi: 10.1093/rheumatology/kes079. Epub 2012 Apr 25.
To characterize steroid use and compliance with glucocorticoid-induced osteoporosis (GIOP) guidelines within a large early inflammatory arthritis cohort.
Using the Canadian Early Arthritis Cohort (CATCH) database, patients with inflammatory arthritis on glucocorticoids (oral, IA and i.m.) were identified. Consecutive steroid exposure was defined as using glucocorticoids for two consecutive clinic visits (at least 90 days apart). The primary outcome was the proportion of patients receiving calcium, vitamin D and a bisphosphonate among patients treated with consecutive oral glucocorticoids.
Six hundred and fifty-five patients were in the CATCH database, where 273 patients were identified as glucocorticoid users, of whom 48% were on oral prednisone, 38% received i.m. or IA and 13% both. The median oral daily dose of prednisone was 5 mg (interquartile range 2.5-10). Consecutive users (CUs, n = 78) compared with non-consecutive users (NUs, n = 532) showed that CUs were older (56 vs 50 years, P = 0.001); females were fewer (63% vs 74%, P = 0.04), but a similar proportion were RF positive (51% in CU vs 56% in NU, P = 0.73). For the primary outcome, rates of prophylaxis for users of consecutive oral steroids were as follows: 53% were treated with calcium, 47% with vitamin D and 25% were on a bisphosphonate. For users of oral prednisone at doses ≥7.5 mg/day, rates of prophylaxis were as follows: 64% were treated with calcium, 57% with vitamin D and 21% were on a bisphosphonate.
Glucocorticoid therapy is frequently used in early inflammatory arthritis. The use of calcium, vitamin D or a bisphosphonate was low among chronic glucocorticoid users and illustrates the need for more diligence in patients receiving glucocorticoids to prevent GIOP.
在一个大型早期炎症性关节炎队列中，描述皮质类固醇的使用情况，并评估其对糖皮质激素诱导性骨质疏松症（GIOP）指南的依从性。
利用加拿大早期关节炎队列（CATCH）数据库，确定正在接受糖皮质激素（口服、关节内和肌内）治疗的炎症性关节炎患者。连续使用皮质类固醇定义为连续两次就诊时使用糖皮质激素（至少间隔 90 天）。主要结局是连续口服糖皮质激素治疗的患者中，接受钙、维生素 D 和双膦酸盐治疗的患者比例。
655 例患者纳入 CATCH 数据库，其中 273 例患者被确定为糖皮质激素使用者，其中 48%接受口服泼尼松龙治疗，38%接受关节内或肌内注射，13%两者兼有。口服泼尼松龙的中位日剂量为 5mg（四分位间距 2.5-10）。与非连续使用者（NU，n=532）相比，连续使用者（CU，n=78）的年龄更大（56 岁 vs 50 岁，P=0.001）；女性更少（63% vs 74%，P=0.04），但 RF 阳性比例相似（CU 为 51%，NU 为 56%，P=0.73）。对于主要结局，连续口服皮质类固醇使用者的预防治疗率如下：53%接受钙治疗，47%接受维生素 D 治疗，25%接受双膦酸盐治疗。对于剂量≥7.5mg/天的口服泼尼松龙使用者，预防治疗率如下：64%接受钙治疗，57%接受维生素 D 治疗，21%接受双膦酸盐治疗。
糖皮质激素治疗在早期炎症性关节炎中经常使用。慢性糖皮质激素使用者中钙、维生素 D 或双膦酸盐的使用情况较低，这表明需要更加注意接受糖皮质激素治疗的患者，以预防 GIOP。
