Use of bisphosphonate might be important to improve bone mineral density in patients with rheumatoid arthritis even under tight control: the TOMORROW study
Use of bisphosphonate might be important to improve bone mineral density in patients with rheumatoid arthritis even under tight control: the TOMORROW study
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即使在严格控制下，使用双膦酸盐对于改善类风湿性关节炎患者的骨矿物质密度也可能很重要：TOMORROW 研究
DOI：
10.1007/s00296-017-3720-7
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发表时间：
2017
期刊：
影响因子：
4
通讯作者：
T. Koike
中科院分区：
文献类型：
--
作者：
M. Tada ;K. Inui;Y. Sugioka;K. Mamoto;T Okano;S. Anno;T. Koike
尽管类风湿关节炎(RA)患者容易发生骨质疏松症，但严格控制疾病活动可能会对骨代谢产生积极影响。我们的目的是确定在疾病活动得到严格控制和糖皮质激素剂量减少的RA患者中，双膦酸盐的使用是否仍然对改善骨密度(BMD)起重要作用。这项研究是从2010年开始对类风湿性关节炎患者风险因素进行全面管理以降低发病率和死亡率：未来10年前瞻性队列的子分析。我们在2010-2013年间使用双能X射线骨密度仪(DXA)在全身模式下比较了192名RA患者和年龄和性别匹配的志愿者的骨密度。然后我们测定骨密度变化率(%Δ骨密度)，用多元Logistic回归分析评估影响患者骨密度增加的因素。在2010-2013年间，在所有调查地点，患者的骨密度显著低于对照组。接受双磷酸盐治疗的患者整个脊柱的%Δ骨密度显著高于未接受治疗的患者(6.2vs.1.8%，P=0.0001)。多因素Logistic回归分析显示，使用双磷酸盐是导致骨密度升高的显著因素(优势比2.13，95%可信区间1.0 3~4.38，P=0.0.041)。同时，生物制剂的使用、糖皮质激素剂量的减少和疾病活动性的控制并不是骨密度增加的重要因素。类风湿性关节炎患者骨密度低于非类风湿性关节炎对照组。在3年的时间里，双膦酸盐的使用显著增加了患者脊柱的骨密度，对于控制炎症和疾病活动性的类风湿关节炎患者的骨密度是重要的。
Although patients with rheumatoid arthritis (RA) are prone to osteoporosis, tight control of disease activity might have a positive effect on bone metabolism. We aimed to determine whether bisphosphonate use is still important to improve bone mineral density (BMD) in RA patients whose disease activity was tightly controlled and the dose of glucocorticoid was reduced. This study was a sub-analysis of the 10-year prospective cohort TOtal Management Of Risk factors in Rheumatoid arthritis patients to lOWer morbidity and mortality: the TOMORROW which started from 2010. We compared BMD between 192 patients with RA and age- and sex-matched volunteers between 2010 and 2013 using dual-energy X-ray absorptiometry (DXA) in whole body mode. We then determined ratios of changes in BMD (%ΔBMD) to assess factors influencing increases in BMD among the patients using multivariate logistic regression analysis. The BMD was significantly lower in the patients than in the controls at all sites surveyed during 2010 and 2013. The %ΔBMD of the total spine was significantly higher among the patients treated with, than without bisphosphonate (6.2 vs. 1.8%,P= 0.0001). Multivariate logistic regression analysis revealed that use of bisphosphonate was a significant factor contributing to BMD increase (odds ratio 2.13; 95% confidence interval, 1.03–4.38,P= 0.041). Meanwhile, use of biologic agents, reducing glucocorticoid dose, and control of disease activity were not significant factors for gain of BMD. The BMD was lower among patients with RA than non-RA controls. Use of bisphosphonate significantly increased the BMD of the spine in patients over a period of 3 years and was important for maintaining the BMD among patients with RA under the control of inflammation and disease activity.