RESEARCH - Incident comorbidity among RA patients treated with steroids or not

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Journal of Rheumatology

Nov 2010

Incident Comorbidity Among Patients with Rheumatoid Arthritis Treated

or Not with Low-dose Glucocorticoids: A Retrospective Study

MAURIZIO MAZZANTINI, ROSARIA TALARICO, MARICA DOVERI, ARIANNA

CONSENSI, MASSIMILIANO CAZZATO, LAURA BAZZICHI and STEFANO BOMBARDIERI

+ Author Affiliations

From the Rheumatology Unit, Department of Internal Medicine,

University of Pisa, Pisa, Italy.

M. Mazzantini, MD, PhD; R. Talarico, MD; M. Doveri, MD; A. Consensi,

MD; M. Cazzato, MD; L. Bazzichi, MD; S. Bombardieri, MD, Chief of

Rheumatology, Chair, Department of Internal Medicine, University of

Pisa.

Abstract

Objective. To assess the prevalence of comorbidity in a cohort of

patients with rheumatoid arthritis (RA), treated or not with low-dose

glucocorticoids (GC) and who have been followed for at least 10 years.

Methods. This was a retrospective study by review of medical records.

Results. We identified 365 patients: 297 (81.3%) were GC users (4–6 mg

methylprednisolone daily) and 68 (18.7%) were nonusers. We found that

fragility fractures occurred in 18.2% of GC users and in 6.0% of GC

nonusers (p < 0.02); arterial hypertension in 32.3% of GC users and in

10.4% of GC nonusers (p < 0.0005); acute myocardial infarction in

13.1% of GC users and in 1.5% of the nonusers (p < 0.01). Prevalence

of diabetes mellitus, cataract, and infections was comparable. We

divided GC users into groups of different duration of GC therapy: < 2,

2–5, and > 5 years; the mean duration of GC treatment was 1.3 ± 0.5,

3.6 ± 1.1, and 12.1 ± 5.1 years, respectively. GC treatment for > 5

years was associated with significantly higher prevalence of fragility

fractures (26.6%; p < 0.001 vs the other groups), arterial

hypertension (36.7%; p < 0.0002 vs nonusers and GC users < 2 years),

myocardial infarction (16.1%; p < 0.01 vs nonusers), and infections

(9.7%; p < 0.005 vs the other groups). GC treatment for 2–5 years was

associated with a significantly higher prevalence of arterial

hypertension (30.0%; p < 0.01) compared to nonusers.

Conclusion. Patients with RA treated with low-dose GC compared to

patients never treated with GC show a higher prevalence of fractures,

arterial hypertension, myocardial infarction, and serious infections,

especially after 5 years of GC treatment. The high prevalence of

myocardial infarction and fractures in patients with RA suggests that

a more accurate identification of risk factors and prevention measures

should be adopted when longterm GC treatment is needed.

http://jrheum.org/content/37/11/2232.abstract

Not an MD