Reducing glucocorticoid dosage improves serum osteocalcin in patients with rheumatoid arthritis -results from the TOMORROW study
Reducing glucocorticoid dosage improves serum osteocalcin in patients with rheumatoid arthritis -results from the TOMORROW study
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减少糖皮质激素剂量可改善类风湿性关节炎患者的血清骨钙素 - TOMORROW 研究结果
DOI：
10.1007/s00198-015-3291-y
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
H. Nakamura
中科院分区：
文献类型：
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作者：
M. Tada;K. Inui;Y. Sugioka;K. Mamoto;T. Okano;T. Koike;H. Nakamura
减少糖皮质激素的日剂量可改善类风湿关节炎患者的骨代谢标志物水平。然而，疾病活动度的变化并不影响骨代谢。因此，即使疾病活动得到很好的控制，骨代谢也可能保持不受控制。减少糖皮质激素用量对改善骨代谢具有重要意义。类风湿性关节炎（RA）患者比健康人更容易发生骨质疏松症。RA患者骨吸收增加，骨形成受到抑制，糖皮质激素对骨代谢有负面影响。我们的目的是研究影响RA患者骨代谢标志物的因素。方法我们从2010年开始进行为期10年的前瞻性队列类风湿性关节炎患者危险因素综合管理以降低发病率和死亡率（TOMORROW）研究。我们比较了2010年至2011年间，202名RA患者和年龄和性别匹配的志愿者的尿I型胶原交联n端肽（uNTx）和血清骨钙素（OC）的变化，分别作为骨吸收和形成的标志物。我们还使用多变量分析调查了影响RA组ΔuNTx和ΔOC的因素。结果RA患者的ΔuNTx值显著低于健康对照组(- 0.51 vs. 7.41 nmol骨胶原当量（BCE)/mmol肌酐（Cr）， p= 0.0013），而RA患者的ΔOC值显著高于健康对照组（0.94 vs. 0.37 ng/ml, p= 0.0065）。泼尼松龙剂量的变化与ΔOC呈负相关（β= - 0.229,p= 0.001），而疾病活动度评分、双膦酸盐治疗和生物制剂治疗时间的变化与ΔOC无显著相关。ΔuNTx与泼尼松龙剂量变化无显著相关性。结论糖皮质激素剂量降低可改善RA患者骨代谢指标，但疾病活动性、双膦酸盐治疗和生物制剂治疗时间对骨代谢指标水平无影响。减少糖皮质激素剂量对改善RA患者骨代谢标志物谱具有重要意义。
SummaryDecreasing the daily dose of glucocorticoids improved bone metabolic marker levels in patients with rheumatoid arthritis. However, changes in disease activity did not influence bone metabolism. Bone metabolism might thus remain uncontrolled even if disease activity is under good control. Decreasing glucocorticoid dosage appears important for improving bone metabolism.IntroductionPatients with rheumatoid arthritis (RA) develop osteoporosis more frequently than healthy individuals. Bone resorption is increased and bone formation is inhibited in patients with RA, and glucocorticoid negatively affects bone metabolism. We aimed to investigate factors influencing bone metabolic markers in patients with RA.MethodsWe started the 10-year prospective cohort Total Management of Risk Factors in Rheumatoid Arthritis Patients to Lower Morbidity and Mortality (TOMORROW) study in 2010. We compared changes in urinary cross-linked N-telopeptide of type I collagen (uNTx) and serum osteocalcin (OC), as markers of bone resorption and formation, respectively, in 202 RA patients and age- and sex-matched volunteers between 2010 and 2011. We also investigated factors influencing ΔuNTx and ΔOC in the RA group using multivariate analysis.ResultsValues of ΔuNTx were significantly lower in patients with RA than in healthy controls (−0.51 vs. 7.41 nmol bone collagen equivalents (BCE)/mmol creatinine (Cr);p= 0.0013), whereas ΔOC values were significantly higher in RA patients (0.94 vs. 0.37 ng/ml;p= 0.0065). Changes in prednisolone dosage correlated negatively with ΔOC (β= −0.229,p= 0.001), whereas changes in disease activity score, bisphosphonate therapy, and period of biologics therapy did not correlate significantly with ΔOC. No significant correlation was seen between ΔuNTx and change in prednisolone dosage.ConclusionsDecreased glucocorticoid dosage improved bone metabolic markers in RA, but disease activity, bisphosphonate therapy, and period of biologics therapy did not influence levels of bone metabolic markers. Decreasing glucocorticoid dosage appears important for improving bone metabolic marker profiles in patients with RA.