Gabriel S E, Sunku J, Salvarani C, O'Fallon W M, Hunder G G
Mayo Clinic, Rochester, Minnesota 55905, USA.
Arthritis Rheum. 1997 Oct;40(10):1873-8. doi: 10.1002/art.1780401022.
To evaluate the incidence and risks of adverse events associated with therapy (both corticosteroids [CS] and nonsteroidal antiinflammatory drugs [NSAIDs]) among a previously identified, population-based cohort of patients first diagnosed with polymyalgia rheumatica (PMR) between 1970 and 1991 who were followed up over the long term.
Information on demographics, PMR diagnosis, disease course, and drug therapy, in addition to data on adverse events commonly associated with CS and NSAID treatment, was obtained from the Rochester Epidemiology Project database. Cox proportional hazards and regression analysis models were used to evaluate the relationship between the occurrence of these events and therapy.
Of the 232 patients (69 male, 163 female) included in the study, the mean age at PMR diagnosis was 72.9 years, the average followup was 8.0 years, and 30 patients were also diagnosed with giant cell (temporal) arteritis. Among the 175 patients (49 male, 126 female) treated with CS, the mean duration of CS therapy was 2.4 years, the average daily dose was 9.6 mg, and the mean cumulative dose was 8.4 gm. In total, 65% of the 124 patients treated with CS alone experienced at least 1 adverse event, compared with 67% of the 57 patients treated with NSAIDs alone and 80% of the 51 patients treated with CS and NSAIDs. The average time from initiation of therapy to the first adverse event was 1.6 years (n = 160). Proportional hazards modeling identified 3 variables that independently increased the risk of adverse events: age at PMR diagnosis, a cumulative dose of prednisone > or = 1,800 mg, and female sex. Person-year analysis revealed that the risks of diabetes mellitus, vertebral fractures, femoral neck fractures, and hip fractures were 2-5 times greater among PMR patients compared with age- and sex-matched individuals from the same population. Medical care or consultation by a rheumatologist was a highly significant predictor of a lower initial CS dose.
The use of CS and NSAIDs in the treatment of PMR is associated with important long-term morbidity.
评估1970年至1991年间首次诊断为风湿性多肌痛（PMR）的、基于人群的队列患者中与治疗相关的不良事件（包括皮质类固醇[CS]和非甾体抗炎药[NSAIDs]）的发生率和风险，这些患者进行了长期随访。
除了从罗切斯特流行病学项目数据库中获取人口统计学、PMR诊断、病程和药物治疗信息外，还获取了与CS和NSAID治疗常见相关不良事件的数据。使用Cox比例风险和回归分析模型来评估这些事件的发生与治疗之间的关系。
纳入研究的232例患者（69例男性，163例女性）中，PMR诊断时的平均年龄为72.9岁，平均随访时间为8.0年，30例患者还被诊断为巨细胞（颞）动脉炎。在接受CS治疗的175例患者（49例男性，126例女性）中，CS治疗的平均持续时间为2.4年，平均每日剂量为9.6mg，平均累积剂量为8.4g。单独接受CS治疗的124例患者中，65%至少经历过1次不良事件，单独接受NSAIDs治疗的57例患者中这一比例为67%，接受CS和NSAIDs治疗的51例患者中这一比例为80%。从开始治疗到首次出现不良事件的平均时间为1.6年（n = 160）。比例风险模型确定了3个独立增加不良事件风险的变量：PMR诊断时的年龄、泼尼松累积剂量≥1800mg以及女性性别。人年分析显示，与来自同一人群的年龄和性别匹配个体相比，PMR患者患糖尿病、椎体骨折、股骨颈骨折和髋部骨折的风险高2至5倍。由风湿病学家进行医疗护理或会诊是较低初始CS剂量的一个非常重要的预测因素。
在PMR治疗中使用CS和NSAIDs与重要的长期发病率相关。
