小剂量激素治疗类风湿关节炎是安全有效的

作者: Roubille C, et al.

翻译：宜昌市第一人民医院孙崇玲<sunchongling@163.com>

摘要: 目的：探讨糖皮质激素（GC）治疗早期类风湿性关节炎（RA）的7年耐受性情况。

方法：将来自（ESPOIR）队列（<6个月疾病持续时间）的602名早期类风湿性关节炎（ERA）患者的数据分为两组：在随访期间至少进行过一次或未接受GC治疗。主要观察指标为死亡、心血管疾病（心梗、脑血管事件、心衰）、严重感染及骨折。

结果：在602例ERA患者中，女性占476例（79%），平均年龄48±12岁。有386例应用了强的松，平均剂量为3.1±2.9mg/日，其中263例（68%）在发病头6个月的时候开始应用GC，平均治疗时间达1057±876天。与未使用GC的患者相比（216例（35.9％）），使用GC的患者更多地使用了非甾体类抗炎药物，合成药物和生物疾病修饰抗风湿病药物，同时具有更多活动性疾病残疾，更高的C反应蛋白和抗心肌酐蛋白质抗体水平。在全部65个事件中，死亡7例、心血管事件14例、严重感染19例及骨折25例。以上不良事件在应用和未应用GC组各占44和21例（p=0.520）。感染较常见，但无明显区别（p=0.09）。

结论：ESPOIR队列的7年资料分析显示，以极小剂量糖皮质激素治疗早期活动性类风湿关节炎有较好的安全性。

附原文: AbstractOBJECTIVE:To explore the 7-year tolerability profile of glucocorticoids (GC) for early rheumatoid arthritis (RA).METHODS:We examined data for 602 patients with RA from the early arthritis Etude et Suivi des POlyarthrites Indifférenciées Récentes (ESPOIR) cohort (<6?6?1months disease duration) stratified into two groups: with or without GC treatment at least once during follow-up (median 7?6?1years (IQR 0.038-7.65)). The main outcome was a composite of death, cardiovascular disease (including myocardial ischaemia, cerebrovascular accident and heart failure), severe infection and fracture.RESULTS:Among the 602 patients with RA (476 women (79%), mean age 48±12?6?1years), 386 with GC (64.1%) received low-dose prednisone (mean 3.1±2.9?6?1mg/day for the entire follow-up): 263 started GC during the first 6?6?1months (68%), and the mean duration of total GC treatment was 1057±876?6?1days. As compared with patients without GC (216 (35.9%)), those with GC showed greater use of non-steroidal anti-inflammatory drugs, synthetic and biological disease-modifying antirheumatic drugs and had more active disease disability, higher C reactive protein and anticitrullinated protein antibody levels. Among 65 events (7 deaths, 14 cardiovascular diseases, 19 severe infections and 25 fractures), 44 and 21 occurred in patients with and without GC (p=0.520). Infections were more frequent, although not significantly, in patients with than without GC (p=0.09). On weighted Cox proportional-hazards analysis, with use of propensity score and inverse-probability-of-treatment weighting, and including age, gender, history of hypertension and GC treatment, outcomes did not differ with and without GC (p=0.520; HR=0.889; 95% CI 0.620 to 1.273).CONCLUSIONS:This 7-year analysis of the ESPOIR cohort supports the good safety profile of very low-dose GC for early active RA.

译自： Roubille C, Rincheval N, Dougados M, Flipo RM, Daurès JP, Combe B.Seven-year tolerability profile of glucocorticoids use in early rheumatoid arthritis: data from the ESPOIR cohort. Ann Rheum Dis. 2017;76(11):1797-1802.