Rheumatology Department, Lapeyronie Hospital, Montpellier University, Montpellier, France.
Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France.
Ann Rheum Dis. 2017 Nov;76(11):1797-1802. doi: 10.1136/annrheumdis-2016-210135. Epub 2017 Feb 17.
To explore the 7-year tolerability profile of glucocorticoids (GC) for early rheumatoid arthritis (RA).
We examined data for 602 patients with RA from the early arthritis Etude et Suivi des POlyarthrites Indifférenciées Récentes (ESPOIR) cohort (<6 months disease duration) stratified into two groups: with or without GC treatment at least once during follow-up (median 7 years (IQR 0.038-7.65)). The main outcome was a composite of death, cardiovascular disease (including myocardial ischaemia, cerebrovascular accident and heart failure), severe infection and fracture.
Among the 602 patients with RA (476 women (79%), mean age 48±12 years), 386 with GC (64.1%) received low-dose prednisone (mean 3.1±2.9 mg/day for the entire follow-up): 263 started GC during the first 6 months (68%), and the mean duration of total GC treatment was 1057±876 days. As compared with patients without GC (216 (35.9%)), those with GC showed greater use of non-steroidal anti-inflammatory drugs, synthetic and biological disease-modifying antirheumatic drugs and had more active disease disability, higher C reactive protein and anticitrullinated protein antibody levels. Among 65 events (7 deaths, 14 cardiovascular diseases, 19 severe infections and 25 fractures), 44 and 21 occurred in patients with and without GC (p=0.520). Infections were more frequent, although not significantly, in patients with than without GC (p=0.09). On weighted Cox proportional-hazards analysis, with use of propensity score and inverse-probability-of-treatment weighting, and including age, gender, history of hypertension and GC treatment, outcomes did not differ with and without GC (p=0.520; HR=0.889; 95% CI 0.620 to 1.273).
This 7-year analysis of the ESPOIR cohort supports the good safety profile of very low-dose GC for early active RA.
探索糖皮质激素（GC）治疗早期类风湿关节炎（RA） 7 年的耐受性情况。
我们对早期关节炎 Etude et Suivi des POlyarthrites Indifférenciées Récentes（ESPOIR）队列中 602 名 RA 患者的数据进行了检查（<6 个月的疾病病程），分为两组：至少在随访期间接受过一次 GC 治疗（中位时间 7 年（IQR 0.038-7.65））和未接受过 GC 治疗。主要结局是死亡、心血管疾病（包括心肌缺血、中风和心力衰竭）、严重感染和骨折的复合事件。
在 602 名 RA 患者（476 名女性（79%），平均年龄 48±12 岁）中，386 名患者（64.1%）接受了低剂量泼尼松（整个随访期间平均 3.1±2.9mg/天）：263 名患者在最初的 6 个月内开始接受 GC（68%），GC 治疗的总持续时间为 1057±876 天。与未接受 GC 的患者（216 名（35.9%））相比，接受 GC 的患者更常使用非甾体抗炎药、合成和生物疾病修饰抗风湿药，且疾病残疾更严重，C 反应蛋白和抗瓜氨酸蛋白抗体水平更高。在 65 例事件（7 例死亡、14 例心血管疾病、19 例严重感染和 25 例骨折）中，有 44 例和 21 例分别发生在接受和未接受 GC 的患者中（p=0.520）。尽管无统计学意义，但接受 GC 的患者感染更常见（p=0.09）。在加权 Cox 比例风险分析中，采用倾向评分和逆概率治疗加权法，并包括年龄、性别、高血压病史和 GC 治疗，接受和未接受 GC 的患者的结局没有差异（p=0.520；HR=0.889；95%CI 0.620 至 1.273）。
这项对 ESPOIR 队列的 7 年分析支持使用极低剂量 GC 治疗早期活动期 RA 的良好安全性。
