M. Mazzantini1,2,3,4,5, Claudia Torre1,2,3,4,5, Mario Miccoli1,2,3,4,5, Angelo Baggiani1,2,3,4,5, Rosaria Talarico1,2,3,4,5, Stefano Bombardieri1,2,3,4,5, Ombretta Di Munno1,2,3,4,5
1Epidemiology Unit, Department of Experimental Pathology MBIE, University of Pisa, Pisa, Italy.
2Epidemiology Unit, Department of Experimental Pathology MBIE, University of Pisa.
3From the Rheumatology Unit, Department of Internal Medicine; and the
4Rheumatology Chair, Rheumatology Unit, Department of Internal Medicine, University of Pisa; M.
5Rheumatology Unit, Ospedale S. Chiara, via Roma 67, 56100 Pisa, Italy.
Tóm tắt
Objective.To assess the occurrence of adverse events in a cohort of patients with polymyalgia rheumatica (PMR), treated with low-dose glucocorticoids (GC).Methods.This was a retrospective study by review of medical records.Results.We identified 222 patients who had a mean duration of followup of 60 ± 22 months and a mean duration of GC therapy of 46 ± 22 months. We found that 95 patients (43%) had at least 1 adverse event after a mean duration of GC therapy of 31 ± 22 months and a mean cumulative dose of 3.4 ± 2.4 g. In particular, 55 developed osteoporosis, 31 had fragility fractures; 27 developed arterial hypertension; 11 diabetes mellitus; 9 acute myocardial infarction; 3 stroke; and 2 peripheral arterial disease. Univariate analysis showed that the duration of GC treatment was significantly associated with osteoporosis (p < 0.0001), fragility fractures (p < 0.0001), arterial hypertension (p < 0.005), and acute myocardial infarction (p < 0.05). Cumulative GC dose was significantly associated with osteoporosis (p < 0.0001), fragility fractures (p < 0.0001), and arterial hypertension (p < 0.01). The adverse events occurred more frequently after 2 years of treatment. Multivariate analysis showed that GC duration was significantly associated with osteoporosis (adjusted OR 1.02, 95% CI 1.02–1.05) and arterial hypertension (adjusted OR 1.03, 95% CI 1.01–1.06); GC cumulative dose was significantly associated with fragility fractures (adjusted OR 1.4, 95% CI 1.03–1.8).Conclusion.Longterm, low-dose GC treatment of PMR is associated with serious adverse events such as osteoporosis, fractures, and arterial hypertension; these adverse events occur mostly after 2 years of treatment.
