Kortikoidihoidon vaikutus nivelreumapotilaan luustoon

Kari Puolakka

Näytön aste: B

Matala-annoksisen kortikoidihoidon haitallinen vaikutus nivelreumapotilaan luustoon on ilmeisesti varsin vähäistä.

In a two-year randomized study «Engvall IL, Svensson B, Tengstrand B ym. Impact of...»1150 patients, 67 % women, with early RA, mean disease duration of 6 months (95 % confidence interval (CI) 3 to 8), who had participated in the BARFOT low-dose prednisolone study were included. They had been randomised to either the P-group, who were treated with 7.5 mg prednisolone daily (n = 70, mean age = 51 years, 95 % CI 48–54), or the NoP-group, who received no prednisolone (n = 80, mean age 58 years, 95 % CI 56–61), when they started their first disease-modifying anti-rheumatic drug (DMARD). Serum samples were analysed at baseline, 3 and 12 months for a marker of bone formation, and the markers of bone degradation. IGF-1 was analysed at baseline and after 12 months. Bone mineral density at the lumbar spine and femoral neck was assessed by dual-energy X-ray absorptiometry at baseline and after 24 months.

Results: Levels of procollagen type I N-terminal propeptide (P1NP) decreased rapidly in the P-group (p < 0.001). Levels of C-telopeptide crosslaps of type I collagen (CTX-1) and C-terminal telopeptide of type I collagen (1 CTP) decreased in both treatment groups, but significantly more in the P-group (differences between groups p < 0.019 and p < 0.001, respectively). IGF-1 increased in the P-group (p < 0.001) but remained stable in the NoP-group. Bone mineral density decreased in the spine in both groups, significantly more in postmenopausal women from the P-group. Femur bone mineral density only decreased in the NoP-group.

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä

Kommentti: Matala-annoksinen kortikoidihoito estää reumatulehduksen luuntiheyttä heikentävän vaikutuksen lonkassa, mutta ei lannerangassa.

A cross-sectional study «Engvall IL, Brismar K, Hafström I ym. Treatment wi...»2 included 100 patients (50 women) with RA with a median (IQR) disease duration of 8 (4–15) years. Fifty patients had been treated with prednisolone (5–7.5 mg) for at least 2 years (the P-group) and 50 patients matched for gender and age had not (the NoP-group).

The P-group had significantly higher fat mass (FM) but similar lean body mass (LBM) and bone mineral density (BMD) compared with the NoP-group. Higher HAQ score and low weight were significantly and independently associated with lower BMD at femoral neck and lumbar spine.

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

Kommentti: Poikkileikkaustutkimus on altis virhelähteille.

Consecutive women (n = 101, 56.1 + 14.2 years) with RA (mean disease duration, 14.9 + 10 years) were recruited in a case-control study assessing the prevalence of vertebral fractures (VFs). Controls (n = 303), randomly selected from the general population, were individually matched to each case for age «Ghazi M, Kolta S, Briot K ym. Prevalence of verteb...»3.

The prevalences of osteoporosis were 55.4 % and 10.5 % and 21.7 % and 4.2 % had a vertebral fracture in the RA and control groups, respectively. Compared with controls, patients with RA had an increased risk of VFs: odds ratio (OR) (CI 95 %) adjusted on body mass index was 6.5 (3.1–13.9). In a multiple logistic regression analysis, VFs were independently associated with presence of non-vertebral fractures (OR = 9.2; 2.5–33.5), presence of a fall in the previous year (OR = 4.6; 1.2–18.3), current use of disease-modifying anti-rheumatic drugs (DMARDs) (OR = 0.05; 0.004–0.51) and current use of steroids (OR = 0.17; 0.04–0.67).

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

Kommentti: Poikkileikkaustutkimus on altis virhelähteille.


  1. Engvall IL, Svensson B, Tengstrand B ym. Impact of low-dose prednisolone on bone synthesis and resorption in early rheumatoid arthritis: experiences from a two-year randomized study. Arthritis Res Ther 2008;10:R128 «PMID: 18986531»PubMed
  2. Engvall IL, Brismar K, Hafström I ym. Treatment with low-dose prednisolone is associated with altered body composition but no difference in bone mineral density in rheumatoid arthritis patients: a controlled cross-sectional study. Scand J Rheumatol 2011;40:161-8 «PMID: 21077801»PubMed
  3. Ghazi M, Kolta S, Briot K ym. Prevalence of vertebral fractures in patients with rheumatoid arthritis: revisiting the role of glucocorticoids. Osteoporos Int 2012;23:581-7 «PMID: 21350894»PubMed