Ann Rheum Dis：与类风湿性关节炎患者骨折风险相关的药物

2019-05-20 xiangting MedSci原创

使用阿片类药物、SSRIs和糖皮质激素与RA患者的骨折风险增加相关，而他汀类药物和TNFi与椎骨骨折减少相关。

这项研究探讨了一个美国观察性类风湿性关节炎（RA）患者队列中，与使用疾病改善性抗风湿药物（DMARDs）、他汀类、质子泵抑制剂（PPIs）、阿片类药物、非阿片类镇痛药和精神药物相关的骨折风险。

FORWARD是一项纵向观察性登记，研究人员对FORWARD 2001年至2017年既往无骨折的RA患者进行骨质疏松相关部位的骨折评估（椎骨、髋、前臂和肱骨）。在4个相互排斥的小组中评估DMARD暴露情况：（1）甲氨蝶呤单药治疗-参考、（2）肿瘤坏死因子-α抑制剂（TNFi）、（3）非TNFi生物制剂和（4）其他。非DMARDs和糖皮质激素被分类为当前/既往使用并且基于治疗时间。计算评估10年骨质疏松性骨折的骨折风险评估工具（FRAX）评分。通过FRAX分层的Cox比例风险模型调整混杂因素。

对11412例患者进行了中位数（IQR）3.0年（1.5-6.0）的随访，共观察到914例骨折。调整模型显示使用任何剂量的糖皮质激素≥3个月（<7.5mg/天 HR（95％CI）1.26（1.07至1.48）；≥7.5mg/天1.57（1.27至1.94））、阿片类药物（弱阿片类：1.37（1.18至1.59）；强阿片类：1.53（1.24至1.88））和选择性血清素再摄取抑制剂（SSRIs）（1.37（1.15至1.63））的骨折风险显著增加。1个月内使用阿片类药物（1.66（1.36至2.04））和使用SSRIs>3个月（1.25（1.01至1.55））的骨折风险增加。他汀类药物（0.77（0.62至0.96））和TNFi（0.72（0.54至0.97））仅与椎骨骨折的风险降低相关。PPIs和其他精神药物与骨折风险增加无关。

使用阿片类药物、SSRIs和糖皮质激素与RA患者的骨折风险增加相关，而他汀类药物和TNFi与椎骨骨折减少相关。

原始出处：

Gulsen Ozen. Medications associated with fracture risk in patients with rheumatoid arthritis. Ann Rheum Dis. 15 May 2019.

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2020-01-28 cmj8wellington

#Dis#

25 0
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2019-05-24 gcwu82

这个不错谢谢

88 0
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2019-05-22 lmm397

#关节炎#

36 0
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2019-05-22 ms4964546379600229

#类风湿#

19 0
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2019-05-22 heli0118

#骨折风险#

24 0
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2019-05-22 ms1467340776200723

#风湿性关节炎#

22 0
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2019-05-21 清风拂面

谢谢分享学习

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