A&R:糖皮质激素注射会增加5年以上膝关节骨关节炎进展的风险吗?

2022-08-23 彼岸河边草 MedSci原创

在这项研究中,关节内(IA)糖皮质激素注射治疗有症状的膝关节骨关节炎(OA)并未显著增加5年全膝关节置换术(TKR)事件或影像学恶化的风险。这些发现应谨慎解释并在其他队列中复制。

目的最近的研究结果表明,关节内(IA)糖皮质激素注射可能对患有骨关节炎(OA)的膝盖有损伤。这项研究旨在在现实生活中评估接受IA糖皮质激素注射的患者在5年的随访期内膝关节OA进展的风险。

方法研究人员使用边缘结构模型和治疗加权的反概率来确IA糖皮质激素注射与膝关节和髋关节骨关节炎长期评估队列中症状性膝关节OA患者5年疾病进展风险之间的因果关系。OA进展被定义为发生全膝关节置换术(TKR)/或影像学恶化(Kellgren/Lawrence [K/L]等级或关节间隙变窄[JSN])。还检查了接受IA透明质酸(IAHA)注射的膝关节的以上结果。

结果在研究样本中包括的564名膝关节OA患者中,51名(9.0%)和99名(17.5%)分别接受了IA糖皮质激素或IAHA注射,414名(63.1%)在随访期间未接受任何注射。与未治疗的膝关节相比,接受IA糖皮质激素注射治疗的膝关节发生TKR(风险比[HR] 0.92[95% 置信区间 (95% CI) 0.20, 4.14]P =0.91)或K/L等级恶化(HR 1.33 [95% CI 0.64, 2.79]P =0.44)的风险相似。IAHA注射对TKR风险(HR 0.81 [95% CI 0.14, 4.63]P =0.81)或 K/L等级恶化(HR 1.36 [95% CI 0.85, 2.17]P =0.20)没有影响。 关节间隙变窄的结局指标,以及当TKR和影像学结果相结合时均获得了类似的结果。

结论在这项研究中,IA糖皮质激素注射治疗有症状的膝关节OA,5年 TKR 事件或影像学恶化的风险未显著增加但是此结果还需要更多进一步的研究来证实它。

出处:Latourte, A., Rat, A.-C., Omorou, A., Ngueyon-Sime, W., Eymard, F., Sellam, J., Roux, C., Ea, H.-K., Cohen-Solal, M., Bardin, T., Beaudreuil, J., Guillemin, F. and Richette, P. (2022), Do Glucocorticoid Injections Increase the Risk of Knee Osteoarthritis Progression Over 5 Years?. Arthritis Rheumatol, 74: 1343-1351. https://doi.org/10.1002/art.42118

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    2022-09-01 lisa438
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    2022-08-24 lmm397
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