Prescription for antiresorptive therapy in Mexican patients with rheumatoid arthritis: is it time to reevaluate the strategies for osteoporosis prevention?
Tóm tắt
Glucocorticoids are frequently used in rheumatoid arthritis (RA) in order to alleviate symptoms of joint inflammation, retard erosions and to treat extra-articular manifestations, although these drugs may increase the risk of bone mineral loss and osteoporotic fractures. To date, in Mexico there are no studies that identify the frequency of patients with RA with corticosteroids, receiving therapy for osteoporosis. Therefore, we evaluated the prevalence and factors related to the prescription of antiresorptives in 520 Mexican patients with RA. We used a multivariate model to identify variables associated with antiresorptives prescription. We identified that although 79% of patients were under treatment with glucocorticoids, only 13% received antiresorptive agents as preventive therapy for osteoporosis. The multivariate analysis identified that higher proportions of antiresorptive drugs prescriptions were associated with female patients (OR 11.40, 95% CI: 1.5–84.3, P = 0.02), an age of 40 years or more (OR 3.22, 95% CI: 1.3–8.3, P = 0.02) and to consume a lower number of cointerventions with other drugs (OR 1.09, 95% CI: 1.0–1.2, P = 0.03). Corticosteroid treatment was not associated with the prescription of antiresorptives (P = 0.31). In conclusion, a low proportion of Mexicans with RA receive antiresorptive therapy independently regardless of whether they consume or not chronically corticosteroids. Additional strategies should be evaluated to encourage the prevention and early treatment for osteoporosis in patients with RA.
Tài liệu tham khảo
Goycochea-Robles MV, Arce-Salinas CA, Guzman-Vazquez S, Cardiel Rios MH (2007) Prescription rheumatology practices among Mexican specialists. Arch Med Res 38:354–359
Bijlsma JW, van der Goes MC, Hoes JN, Jacobs JW, Buttgereit F, Kirwan J (1992) Low-dose glucocorticoid therapy in rheumatoid arthritis: an obligatory therapy. Ann NY Acad Sci 1193:123–126
Sokka T, Envalds M, Pincus T (2008) Treatment of rheumatoid arthritis: a global perspective on the use of antirheumatic drugs. Mod Rheumatol 18:228–239
Bijlsma JWJ (1998) Long-term glucocorticoid treatment of rheumatoid arthritis: risk or benefit? Rheumatol Eur 27:67–71
de Nijs RN, Jacobs JW, Bijlsma JW, Lems WF, Laan RF, Houben HH, ter Borg EJ, Huisman AM, Bruyn GA, van Oijen PL, Westgeest AA, Algra A, Hofman DM, Osteoporosis Working Group Dutch Society for Rheumatology (2001) Prevalence of vertebral deformities and symptomatic vertebral fractures in corticosteroid treated patients with rheumatoid arthritis. Rheumatology 40:1375–1383
Peel NF, Moore DJ, Barrington NA, Bax DE, Eastell R (1995) Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis. Ann Rheum Dis 54:801–806
Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000
Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology 39:1383–1389
Aguilar-Chavez EA, Gamez-Nava JI, Lopez-Olivo MA, Galvan-Melendres S, Corona-Sanchez EG, Loaiza-Cardenas CA, Celis A, Cardona-Muñoz EG, Gonzalez-Lopez L (2009) Circulating leptin and bone mineral density in rheumatoid arthritis. J Rheumatol 36:512–516
Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis (2001) Arthritis Rheum 44:1496–1503
Saag KG, Emkey R, Schnitzer TJ, Brown JP, Hawkins F, Goemaere S, Thamsborg G, Liberman UA, Delmas PD, Malice MP, Czachur M, Daifotis AG (1998) Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. Glucocorticoid-induced osteoporosis intervention study group. N Engl J Med 339:292–299
Reid DM, Hughes RA, Laan RF, Sacco-Gibson NA, Wenderoth DH, Adami S, Eusebio RA, Devogelaer JP (2000) Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. European corticosteroid-induced osteoporosis treatment study. J Bone Miner Res 15:1006–1013
Adachi JD, Bensen WG, Brown J, Hanley D, Hodsman A, Josse R, Kendler DL, Lentle B, Olszynski W, Ste-Marie LG, Tenenhouse A, Chines AA (1997) Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med 337:382–387
Cohen S, Levy RM, Keller M, Boling E, Emkey RD, Greenwald M, Zizic TM, Wallach S, Sewell KL, Lukert BP, Axelrod DW, Chines AA (1999) Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum 42:2309–2318
Roux C, Oriente P, Laan R, Hughes RA, Ittner J, Goemaere S, Di Munno O, Pouillès JM, Horlait S, Cortet B (1998) Randomized trial of effect of cyclical etidronate in the prevention of corticosteroid-induced bone loss. Ciblos study group. J Clin Endocrinol Metab 83:1128–1133
Wallach S, Cohen S, Reid DM, Hughes RA, Hosking DJ, Laan RF, Doherty SM, Maricic M, Rosen C, Brown J, Barton I, Chines AA (2000) Effects of risedronate treatment on bone density and vertebral fracture inpatients on corticosteroid therapy. Calcif Tissue Int 67:277–285
National Osteoporosis Foundation (2010) Clinician‘s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation. Washington, DC. Retrieved from: http://www.nof.org
Solomon DH, Katz JN, Cabral D, Patrick AR, Bukowski JF, Coblyn JS (2006) Osteoporosis management in patients with rheumatoid arthritis: evidence for improvement. Arthritis Rheum 55:873–877
Solomon DH, Katz JN, Jacobs JP, La Tourette AM, Coblyn J (2002) Management of glucocorticoid-induced osteoporosis in patients with rheumatoid arthritis: rates and predictors of care in an academic rheumatology practice. Arthritis Rheum 46:3136–3142
Walsh LJ, Wong CA, Pringle M, Tattersfield AE (1996) Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. BMJ 313:344–346
Morales-Romero J, Cázares-Méndez JM, Gámez-Nava JI, Triano-Páez M, Villa-Manzano AI, López-Olivo MA, Rodríguez-Arreola BE, González-López L (2005) Patterns of health care in an out patient rheumatologic clinic. Reumatol Clin 1:87–94
Peat ID, Healy S, Reid DM, Ralston SH (1995) Steroid induced osteoporosis: an opportunity for prevention? Ann Rheum Dis 54:66–68
Feldstein AC, Elmer PJ, Nichols GA, Herson M (2005) Practice patterns in patients at risk for glucocorticoid-induced osteoporosis. Osteoporos Int 16:2168–2174
Civitelli R, Ziambaras K (2008) Epidemiology of glucocorticoid-induced osteoporosis. J Endocrinol Invest 31(7 Suppl):2–6