Reduced loss of hand bone density with prednisolone in early rheumatoid arthritis - Results from a randomized placebo-controlled trial
Reduced loss of hand bone density with prednisolone in early rheumatoid arthritis - Results from a randomized placebo-controlled trial
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DOI：
10.1001/archinte.165.11.1293
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发表时间：
2005-06-13
影响因子：
--
通讯作者：
Kirwan, JR
中科院分区：
文献类型：
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作者：
Haugeberg, G;Strand, A;Kirwan, JR
背景：类风湿性关节炎的骨损伤表现为骨质疏松和关节糜烂。强的松龙已经被证明可以减少手部关节破坏的速度，从x线照片上可以看到，但还没有被证明可以减少手部骨质流失的速度。方法：在一项比较口服强的松龙（7.5 mg/d， 2年）和安慰剂的双盲研究中，对95例病程少于2年的类风湿关节炎患者用数字x线放射测量法评估了手骨密度。结果：与安慰剂组相比，强的松龙组1年随访时（-0.011 vs -0.022 g/cm(2)）和2年随访时（-0.026 vs -0.039 g/cm(2)）手部骨密度的平均损失更少（P= 0.03）。1年随访时，各年龄组手部骨密度损失的平均百分比差异为2.8% (P= 0.004)， 2年随访时为3.5% （P= 0.01）。在第一年，c反应蛋白（炎症的一种标志）在安慰剂治疗的患者中与手部骨质流失密切相关，而在强的松龙治疗的患者中则没有，这表明强的松龙打破了骨质流失和炎症之间的联系。结论：据我们所知，这是第一个双盲随机研究，显示疾病相关的类风湿性关节炎手部骨密度损失可以通过强的松龙来减缓。这一发现表明，强的松龙对骨骼的有害作用可能被其抗炎作用所抵消。
Background: Bone damage in rheumatoid arthritis presents as osteoporosis and joint erosions. Prednisolone has been shown to reduce the rate of hand joint destruction as seen on radiography but has not been shown to reduce the rate of hand bone loss.Methods: In a double-blind study comparing oral prednisolone (7.5 mg/d for 2 years) with placebo, hand bone density assessed with digital x-ray radiogrammetry was examined in 95 patients with rheumatoid arthritis with disease duration of less than 2 years.Results: The mean loss of hand bone density was less in prednisolone-treated patients compared with placebo-treated patients at the 1-year follow-up (-0.011 vs -0.022 g/cm(2)) (P=.005) and at the 2-year follow-up (-0.026 vs -0.039 g/cm(2)) (P=.03). The mean percent-age group difference in loss of hand bone density was 2.8% (P=.004) at the 1-year follow-up and 3.5% (P=.01) at the 2-year follow-up. In the first year, C-reactive protein, a marker of inflammation, was strongly correlated with hand bone loss in placebo-treated patients but not in prednisolone-treated patients, suggesting that prednisolone breaks the link between bone loss and inflammation.Conclusions: To our knowledge, this is the first double-blind randomized study to show that disease-related loss of hand bone density in rheumatoid arthritis can be decelerated by prednisolone. This finding suggests that the deleterious effect of prednisolone on bone may be counteracted by its anti-inflammatory effect.