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The impact of low-dose glucocorticoids on disease activity, bone mineral density, fragility fractures, and 10-year probability of fractures in patients with rheumatoid arthritis
  1. Tien-Tsai Cheng1,2,
  2. Han-Ming Lai1,
  3. Shan-Fu Yu1,2,
  4. Wen-Chan Chiu1,
  5. Chung-Yuan Hsu1,
  6. Jia-Feng Chen1,
  7. Ying-Chou Chen1,2
  1. 1 Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
  2. 2 Chang Gung University College of Medicine, Kaohsiung, Taiwan
  1. Correspondence to Dr Ying-Chou Chen, Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; r820713{at}ms13.hinet.net

Abstract

This study aimed to investigate the effect of low-dose glucocorticoids (LDGs) on disease activity, bone density, and fractures in patients with rheumatoid arthritis (RA). This was an interim analysis of the RA Registry. Demographic data and clinical characteristics, including fracture risk assessment tool, were collected. 25(OH) Vitamin D, bone mineral density (BMD), and intact parathyroid hormone were measured at enrollment. The study group were those who took LDGs (2.5–7.5 mg/day prednisolone or equivalent dose), and the others were included as the control group. A total of 425 participants were enrolled, including 85 (20%) in the control group and 340 (80%) in the study group. The demographics and clinical characteristics were comparable between the two groups. Compared with the control group, the LDGs group had a significantly lower vertebral BMD (L 1–4) (g/cm2), (0.854 vs 0.896, p=0.046), significantly higher rate of previous fractures (103 (30.3%) vs 13 (15.3%), p=0.006), higher 10-year probability of major fractures (14 (15.5) vs 8 (8.6), p<0.0001), and higher 10-year probability of hip fractures (4.4 (8.4) vs 2 (3.9), p<0.0001). Disease activity appeared to be similar in the patients with RA regardless of whether or not they received LDG treatment. However, the patients with RA who received LDG treatment had a lower BMD at the spine (L1–4) and a higher rate of previous fractures that was associated with a significantly higher 10-year probability of fractures than those who did not receive LDG treatment.

  • osteoporosis
  • osteoporotic fractures

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Footnotes

  • Contributors T-TC and H-ML designed and performed the research. S-FY, W-CC, C-YH, and J-FC performed rheumatoid arthritis care. T-TC and Y-CC wrote the final paper.

  • Funding This study was supported by Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung grant. CMRPG8E1221.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This retrospective study was approved by the institutional review board of Chang Gung Memorial Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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