Amann Jonna, Wessels Anne-Marie, Breitenfeldt Friederike, Huscher Dörte, Bijlsma Johannes W J, Jacobs Johannes W G, Buttgereit Frank
Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany.
Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, the Netherlands.
Clin Exp Rheumatol. 2017 May-Jun;35(3):471-476. Epub 2017 Jan 15.
EULAR guidelines state that adverse effects (AEs) of glucocorticoid (GC) therapy should be considered and discussed with the patient before treatment is initiated. However, reliable quantitative data, especially on cutaneous AEs of low-to-medium dose GCs are lacking. We performed a study assessing the occurrence of cutaneous AEs of GCs and its association with current and cumulative GC doses in patients with rheumatoid arthritis (RA).
In a cross-sectional study performed in 2 outpatient rheumatology centres, 381 RA patients were enrolled. They were classed into 4 groups, according their mean daily dose during the past 12 months: 0 mg (n=87), <5mg (n=108), 5-7.5 mg (n=130), and >7.5 mg (n=56) of prednisone equivalent. AEs of GC on the skin were assessed by physical examination using a predefined scoring system, and by patients' self-assessments. Data were analysed according GC dose categories and cumulative doses.
Cushingoid habitus, easy bruising, skin atrophy, and impaired wound healing as reported by patients occurred significantly more frequently in those using a GC the past 12 months, compared to those not using a GC. At physicians' assessments, only Cushingoid habitus and ecchymosis were more prevalent in GC users. The prevalence of these AEs was statistically significantly positively associated with current and cumulative GC dose. There was low occurrence of abnormal stretch marks, acne, perioral dermatitis, alopecia and hirsutism, which were not correlated with GC use.
Certain GC-associated cutaneous AEs are common in RA, but other AEs of GC occur infrequently at the low-to-medium GC doses used in RA.
欧洲抗风湿病联盟（EULAR）指南指出，在开始糖皮质激素（GC）治疗前，应考虑其不良反应（AE）并与患者进行讨论。然而，目前缺乏可靠的定量数据，尤其是关于低至中等剂量GC的皮肤不良反应的数据。我们开展了一项研究，评估类风湿关节炎（RA）患者中GC皮肤不良反应的发生情况及其与当前和累积GC剂量的关系。
在2个门诊风湿病中心进行的一项横断面研究中，纳入了381例RA患者。根据过去12个月的平均每日剂量，将他们分为4组：泼尼松等效剂量为0 mg（n = 87）、<5 mg（n = 108）、5 - 7.5 mg（n = 130）和>7.5 mg（n = 56）。通过使用预定义评分系统的体格检查以及患者的自我评估来评估GC对皮肤的不良反应。根据GC剂量类别和累积剂量对数据进行分析。
与未使用GC的患者相比，过去12个月使用GC的患者报告的库欣样体型、易瘀斑、皮肤萎缩和伤口愈合受损的情况明显更频繁。在医生的评估中，只有库欣样体型和瘀斑在GC使用者中更为普遍。这些不良反应的发生率与当前和累积GC剂量在统计学上呈显著正相关。异常妊娠纹、痤疮、口周皮炎、脱发和多毛症的发生率较低且与GC使用无关。
某些与GC相关的皮肤不良反应在RA中很常见，但在RA中使用的低至中等剂量GC时，其他GC不良反应很少发生。
