Prevalence of vertebral fractures in patients with rheumatoid arthritis: revisiting the role of glucocorticoids
Prevalence of vertebral fractures in patients with rheumatoid arthritis: revisiting the role of glucocorticoids
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DOI：
10.1007/s00198-011-1584-3
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发表时间：
2012-02-01
影响因子：
4
通讯作者：
Roux, C.
中科院分区：
文献类型：
--
作者：
Ghazi, M.;Kolta, S.;Roux, C.
椎体骨折评估（VFA）是诊断RA椎体骨折的便捷工具。最佳控制炎症可能是防止椎体骨折的有效手段。本病例对照研究的目的是利用VFA技术评估RA患者椎体骨折（VFs）的发生率。研究招募了连续患有RA的女性（N = 101, 56.1 +/- 14.2年）（平均病程14.9 +/- 10年）。评估临床和生物学状况以及包括糖皮质激素在内的治疗方法。对照（N = 303），从一般人群中随机选择，分别与每个病例的年龄相匹配。骨质疏松症的患病率分别为55.4%和10.5%。RA组和对照组分别有21.7%和4.2%的受试者发生过椎体骨折。与对照组相比，RA患者发生VFs的风险增加：经体重指数调整后的比值比（OR） （CI 95%）为6.5（3.1,13.9）。在多元logistic回归分析中，VFs与非椎体骨折的存在（OR = 9.2[2.5-33.5]）、前一年跌倒的存在（OR = 4.6[1.2-18.3]）、目前使用的改善疾病的抗风湿药物（DMARDs） （OR = 0.05[0.004, 0.51]）和目前使用的类固醇（OR = 0.17[0.04, 0.67]）独立相关。类风湿关节炎是VF的危险因素（OR = 6.5）。VFA是一种方便的诊断工具。VF的存在与DMARD和糖皮质激素的使用呈负相关，加强了对疾病的适当控制可能是防止骨骼脆弱的保护因素的假设。
Vertebral fracture assessment (VFA) is a convenient tool for the diagnosis of vertebral fracture in RA. Optimal control of inflammation may be an effective means to protect against vertebral fractures.The aim of this case-control study was to assess the prevalence of vertebral fractures (VFs) in patients with RA using VFA technology.Consecutive women (N = 101, 56.1 +/- 14.2 years) with RA (mean disease duration, 14.9 +/- 10 years) were recruited in the study. Clinical and biological statuses and treatments including glucocorticoids were assessed. Controls (N = 303), randomly selected from the general population, were individually matched to each case for age.The prevalences of osteoporosis were 55.4% and 10.5% in patients and controls, respectively. Among the subjects, 21.7% and 4.2% had a vertebral fracture in the RA and control groups, respectively. Compared with controls, patients with RA had an increased risk of VFs: odds ratio (OR) (CI 95%) adjusted on body mass index was 6.5 (3.1, 13.9). In a multiple logistic regression analysis, VFs were independently associated with presence of non-vertebral fractures (OR = 9.2 [2.5-33.5]), presence of a fall in the previous year (OR = 4.6 [1.2-18.3]), current use of disease-modifying anti-rheumatic drugs (DMARDs) (OR = 0.05 [0.004, 0.51]) and current use of steroids (OR = 0.17 [0.04, 0.67]).Rheumatoid arthritis is a risk factor of VF (OR = 6.5). VFA is a convenient tool for this diagnosis. Presence of VF is inversely related to the use of DMARD and glucocorticoids, enhancing the hypothesis that an appropriate control of the disease may be a protective factor against bone fragility.