Bone mineral density in patients with early rheumatoid arthritis treated with corticosteroids
Bone mineral density in patients with early rheumatoid arthritis treated with corticosteroids
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DOI：
10.1007/s10067-004-0989-1
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发表时间：
2005-04-01
影响因子：
3.4
通讯作者：
Haj, S
中科院分区：
文献类型：
--
作者：
Habib, GS;Haj, S
本研究的目的是评估早期类风湿关节炎（RA）患者在加用小剂量皮质类固醇（CS）治疗前和治疗后6个月的骨密度（BMD）。患有早期RA（症状持续时间< 1年）和在最大剂量非甾体抗炎药（NSAIDS）下的严重关节疼痛的成人患者（> 21岁）开始接受低剂量泼尼松（10 mg/天）。在1、3和6个月后对患者进行评估。记录疾病活动性指标，包括肿胀和压痛关节计数、红细胞沉降率（ESR）和C反应蛋白（CRP），并根据每次访视时的疼痛程度调整泼尼松的剂量。在开始CS治疗前和治疗后6个月，使用双能X线吸收法测量股骨颈（FN）和腰椎（LS）的BMD。研究期间不允许使用可能影响BMD的钙补充剂、维生素D、双膦酸盐或激素治疗。20例患者符合条件，16例完成研究; 75%为女性。平均年龄为47.2 ± 12岁，平均症状持续时间为7 ± 2个月。开始CS治疗前和治疗后6个月FN的平均BMD分别为0.8080 g/cm（2）+/- 0.1145和0.8242 g/cm（2）+/- 0.1122（p= 0.04）。开始CS治疗前和治疗后6个月LS的平均BMD分别为0.9429 g/cm（2）+/- 0.1406和0.9490 g/ cm（2）+/- 0.1277（p= 0.423）。FN处BMD的平均变化与压痛关节计数（p = 0.01）、ESR（p=0.008）和CRP（p=0.006）的平均变化之间存在显著相关性，但与肿胀关节计数无关（p=0.099）。然而，FN或LS的BMD变化与每位患者的任何疾病活动度指标的变化之间没有相关性。此外，CS累积剂量与BMD变化之间没有相关性。早期RA患者在治疗中加入低剂量CS 6个月后，FN处的BMD显著增加。
The aim of this study was to evaluate the bone mineral density (BMD) in patients with early rheumatoid arthritis ( RA) prior to and 6 months after adding low-dose corticosteroid ( CS) treatment. Adult patients (> 21 years old) with early RA ( symptom duration < 1 year) and severe joint pain under maximal dose of nonsteroidal anti-inflammatory drugs (NSAIDS) were started on low-dose prednisone ( 10 mg/day). Patients were evaluated after 1, 3, and 6 months. Disease activity measures including swollen and tender joint count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were documented, and the dose of prednisone was adjusted according to the level of pain at each visit. BMD of the femoral neck (FN) and lumbar spine (LS) was measured using dual energy X-ray absorptiometry prior to and 6 months after starting CS treatment. Calcium supplements, vitamin D, bisphosphonates, or hormonal therapy that may affect BMD were not permitted during the study. Twenty patients were eligible and 16 completed the study; 75% were female. The mean age was 47.2 +/- 12 years and mean duration of symptoms was 7 +/- 2 months. The mean BMD at the FN prior to and 6 months after starting CS treatment were 0.8080 g/cm(2) +/- 0.1145 and 0.8242 g/cm(2) +/- 0.1122, respectively ( p= 0.04). The mean BMD at the LS prior to and 6 months after starting CS treatment were 0.9429 g/cm(2) +/- 0.1406 and 0.9490 g/ cm(2) +/- 0.1277, respectively ( p= 0.423). There was a significant correlation between the mean change of BMD at the FN and mean change of tender joint count (p = 0.01), ESR (p=0.008), and CRP (p=0.006) but not with swollen joint count (p=0.099). However, there was no correlation between the change of BMD at the FN or LS and the change of any of the disease activity measures of every patient. Also, no correlation was seen between the cumulative dose of CS and the change in BMD. BMD increases significantly at the FN in early RA patients 6 months after adding low-dose CS to the treatment.