Wilson Jessica C, Sarsour Khaled, Collinson Neil, Tuckwell Katie, Musselman David, Klearman Micki, Napalkov Pavel, Jick Susan S, Stone John H, Meier Christoph R
Basel Pharmacoepidemiology Unit, University of Basel, Basel, Switzerland.
Genentech, South San Francisco, CA, USA.
Semin Arthritis Rheum. 2017 Apr;46(5):650-656. doi: 10.1016/j.semarthrit.2016.10.001. Epub 2016 Oct 13.
Giant cell arteritis (GCA) is an inflammatory disorder of blood vessels that preferentially affects large- and medium-sized arteries. High-dose oral corticosteroids (CS) are the mainstay of GCA therapy. Using data from the UK Clinical Practice Research Datalink, we quantified and compared the incidence of selected potentially CS-associated adverse outcomes in patients with and without GCA.
We conducted a retrospective follow-up study of GCA and non-GCA patients to examine the incidence of adverse outcomes attributable to CS use. Eligibility criteria for the GCA group included a first-time diagnosis of GCA at age 50 years or older with receipt of ≥1 prescription(s) for prednisolone. GCA patients were matched to a GCA-free comparison group of equal size on age, sex, general practice, and calendar time. We estimated incidence rates and incidence rate ratios (IRRs) for diabetes, osteoporosis, glaucoma, fractures, serious infection requiring hospitalization, and death for GCA and non-GCA patients and compared all-cause hospitalizations between the two groups.
The cohort consisted of 5011 GCA and 5011 matched non-GCA patients. Approximately 74% were women, and mean age at GCA diagnosis was 72.9 years. The IR for all outcomes was greater in the GCA group than the non-GCA group. IRRs [95% confidence intervals (CIs)] were as follows: diabetes 1.4 (1.2-1.7), osteoporosis 2.4 (2.1-2.8), fractures 1.4 (1.2-1.6), glaucoma 2.0 (1.6-2.5), serious infection requiring hospitalization 1.5 (1.3-1.7), and death 1.2 (1.0-1.3).
Compared with age- and sex-matched non-GCA patients, patients with GCA were at increased risk for diabetes, osteoporosis, fracture, and glaucoma and at a marginally increased risk for death.
巨细胞动脉炎（GCA）是一种血管炎性疾病，主要累及大中型动脉。大剂量口服糖皮质激素（CS）是GCA治疗的主要手段。利用英国临床实践研究数据链的数据，我们对有和没有GCA的患者中选定的潜在CS相关不良结局的发生率进行了量化和比较。
我们对GCA患者和非GCA患者进行了一项回顾性随访研究，以检查因使用CS导致的不良结局发生率。GCA组的纳入标准包括年龄在50岁及以上首次诊断为GCA且接受过≥1次泼尼松龙处方。将GCA患者与年龄、性别、全科医疗和日历时间匹配的同等规模的无GCA对照组进行匹配。我们估计了GCA患者和非GCA患者糖尿病、骨质疏松症、青光眼、骨折、需要住院治疗的严重感染和死亡的发病率和发病率比（IRR），并比较了两组之间的全因住院情况。
该队列由5011名GCA患者和5011名匹配的非GCA患者组成。大约74%为女性，GCA诊断时的平均年龄为72.9岁。GCA组所有结局的发病率均高于非GCA组。IRR[95%置信区间（CI）]如下：糖尿病1.4（1.2 - 1.7），骨质疏松症2.4（2.1 - 2.8），骨折1.4（1.2 - 1.6），青光眼2.0（1.6 - 2.5），需要住院治疗的严重感染1.5（1.3 - 1.7），死亡1.2（1.0 - 1.3）。
与年龄和性别匹配的非GCA患者相比，GCA患者患糖尿病、骨质疏松症、骨折和青光眼的风险增加，死亡风险略有增加。
