糖皮质激素与类风湿关节炎患者的椎体骨折风险增加相关。
Glucocorticoids Are Associated with an Increased Risk for Vertebral Fracture in Patients with Rheumatoid Arthritis.
机构信息
From the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul; Department of Statistics, Kyungpook National University, Daegu; Department of Information Statistics, Andong National University, Andong, South Korea.
D. Kim, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; S.K. Cho, MD, PhD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; B. Park, MS, Department of Statistics, Kyungpook National University; E.J. Jang, PhD, Department of Information Statistics, Andong National University; S.C. Bae, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; Y.K. Sung, MD, PhD, MPH, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases.
出版信息
J Rheumatol. 2018 May;45(5):612-620. doi: 10.3899/jrheum.170054. Epub 2018 Mar 15.
OBJECTIVE
To identify the effects of glucocorticoids (GC) on various types of fractures in patients with rheumatoid arthritis (RA).
METHODS
We used the Korean National Healthcare Claims database from 2010 to establish a retrospective cohort of patients with RA ≥ 19 years old. We then followed those patients through December 2013. The incidence rates of total and major fractures were calculated. We evaluated the effects of GC dose and duration on fractures using multivariable logistic regression analyses. We also examined the influence of GC on fractures in RA patients without a history of osteoporosis.
RESULTS
A total of 11,599 fractures was observed in 9964 out of 138,240 patients with RA. During followup, 68.2% of patients used oral GC for > 3 months. Adjusted analysis showed the risk of vertebral fractures was increased by the following characteristics: duration of GC ≥ 6 months (OR 1.76, p < 0.01); mean dose of GC ≥ 2.5 mg (OR range = 1.37-1.71, p < 0.01); and highest daily dose of GC ≥ 10 mg (OR range = 1.23-1.75, p < 0.03). However, neither the duration nor the dose of oral GC increased the risk of hip and nonvertebral/nonhip fractures in patients with RA. Consistent results were observed in RA patients without osteoporosis.
CONCLUSION
Longer duration and higher dose of oral GC in patients with RA increased the risk of vertebral fractures. However, the dose and duration of GC did not influence the risk of hip and nonvertebral/nonhip fractures.
目的
确定糖皮质激素（GC）对类风湿关节炎（RA）患者各种类型骨折的影响。
方法
我们使用了 2010 年至 2013 年 12 月的韩国国家医疗保险索赔数据库，建立了一个年龄≥19 岁的 RA 患者回顾性队列。我们计算了总骨折和主要骨折的发生率。我们使用多变量逻辑回归分析评估了 GC 剂量和持续时间对骨折的影响。我们还检查了 GC 对无骨质疏松症病史的 RA 患者骨折的影响。
结果
在 138240 例 RA 患者中，有 9964 例患者发生了 11599 例骨折。在随访期间，68.2%的患者口服 GC 治疗>3 个月。调整分析显示，GC 持续时间≥6 个月（OR 1.76，p<0.01）；GC 平均剂量≥2.5mg（OR 范围=1.37-1.71，p<0.01）；以及最高日剂量 GC≥10mg（OR 范围=1.23-1.75，p<0.03），会增加椎体骨折的风险。然而，RA 患者的 GC 持续时间和剂量均未增加髋部和非椎体/非髋部骨折的风险。在无骨质疏松症的 RA 患者中观察到了一致的结果。
结论
RA 患者口服 GC 的持续时间延长和剂量增加会增加椎体骨折的风险。然而，GC 的剂量和持续时间并不影响髋部和非椎体/非髋部骨折的风险。
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