Long-term use of glucocorticoids in patients with active rheumatoid arthritis: therapeutic "freeze frame"
Background. In Russia, as well as throughout the world, the use of glucocorticoids (GC) in the treatment of rheumatoid arthritis (RA) is widespread, often going beyond the recommendations for both duration and dose regimen, which makes it relevant to study the long-term consequences of such a wrong...
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| Format: | Article |
| Language: | Russian |
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"Consilium Medicum" Publishing house
2023-07-01
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| Series: | Терапевтический архив |
| Subjects: | |
| Online Access: | https://ter-arkhiv.ru/0040-3660/article/viewFile/551819/132626 |
| _version_ | 1797772965471846400 |
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| author | Andrey V. Gordeev Elena V. Matyanova Elena A. Galushko |
| author_facet | Andrey V. Gordeev Elena V. Matyanova Elena A. Galushko |
| author_sort | Andrey V. Gordeev |
| collection | DOAJ |
| description | Background. In Russia, as well as throughout the world, the use of glucocorticoids (GC) in the treatment of rheumatoid arthritis (RA) is widespread, often going beyond the recommendations for both duration and dose regimen, which makes it relevant to study the long-term consequences of such a wrong (EULAR, 2022) use of GC in RA therapy.
Materials and methods. Of 1143 patients with active RA (ACR/EULAR 2010), two groups were formed: A (n=782) RA patients with more than 6 months of experience with systemic GC; group B (n=245) no experience of taking GC. The cumulative disease index (CIRS) was used to assess the comorbidity profile.
Results. Patients in group A were older (p0.0001), with a longer duration of RA (p=0.0004) and more often with IV radiological stage (p=0.02). With comparable (DAS28) RA activity, the D2T variant of RA was more often detected in them (p=0.036). RA therapy in group A was characterized by a large number of used disease-modifying anti-rheumatic drugs (p=0.0003), more frequent development of methotrexate-induced hepatitis (p=0.03). In group A, the time interval between the onset of RA and the initiation of biological therapy was longer (p=0.0001) and directly correlated with the duration of GC therapy (Rs=0.38) with a comparable qualitative structure of the used b/tsDMARDs. In the same group, tuberculosis, hypertension, chronic kidney disease, cataract and osteoporosis (p0.05) and its complications were diagnosed significantly more often with a comparable frequency of cardiovascular disease, diabetes, and gastrointestinal lesions. In group A, a higher CIRS multimorbidity index was detected, and the CIRS severity index was lower than in group B (p0.05).
Conclusion. Long-term use of GC did not lead to a decrease in disease activity, inhibition of radiographic progression, delayed the timely administration of b/tsDMARDS and was accompanied by an increase in the multimorbid load. |
| first_indexed | 2024-03-12T21:59:26Z |
| format | Article |
| id | doaj.art-d19ed0da1499460d8875e4c13173b267 |
| institution | Directory Open Access Journal |
| issn | 0040-3660 2309-5342 |
| language | Russian |
| last_indexed | 2024-03-12T21:59:26Z |
| publishDate | 2023-07-01 |
| publisher | "Consilium Medicum" Publishing house |
| record_format | Article |
| series | Терапевтический архив |
| spelling | doaj.art-d19ed0da1499460d8875e4c13173b2672023-07-25T11:14:52Zrus"Consilium Medicum" Publishing houseТерапевтический архив0040-36602309-53422023-07-0195538038510.26442/00403660.2023.05.20219678291Long-term use of glucocorticoids in patients with active rheumatoid arthritis: therapeutic "freeze frame"Andrey V. Gordeev0https://orcid.org/0000-0001-9820-8851Elena V. Matyanova1https://orcid.org/0000-0003-2135-5524Elena A. Galushko2Nasonova Research Institute of RheumatologyNasonova Research Institute of RheumatologyNasonova Research Institute of RheumatologyBackground. In Russia, as well as throughout the world, the use of glucocorticoids (GC) in the treatment of rheumatoid arthritis (RA) is widespread, often going beyond the recommendations for both duration and dose regimen, which makes it relevant to study the long-term consequences of such a wrong (EULAR, 2022) use of GC in RA therapy. Materials and methods. Of 1143 patients with active RA (ACR/EULAR 2010), two groups were formed: A (n=782) RA patients with more than 6 months of experience with systemic GC; group B (n=245) no experience of taking GC. The cumulative disease index (CIRS) was used to assess the comorbidity profile. Results. Patients in group A were older (p0.0001), with a longer duration of RA (p=0.0004) and more often with IV radiological stage (p=0.02). With comparable (DAS28) RA activity, the D2T variant of RA was more often detected in them (p=0.036). RA therapy in group A was characterized by a large number of used disease-modifying anti-rheumatic drugs (p=0.0003), more frequent development of methotrexate-induced hepatitis (p=0.03). In group A, the time interval between the onset of RA and the initiation of biological therapy was longer (p=0.0001) and directly correlated with the duration of GC therapy (Rs=0.38) with a comparable qualitative structure of the used b/tsDMARDs. In the same group, tuberculosis, hypertension, chronic kidney disease, cataract and osteoporosis (p0.05) and its complications were diagnosed significantly more often with a comparable frequency of cardiovascular disease, diabetes, and gastrointestinal lesions. In group A, a higher CIRS multimorbidity index was detected, and the CIRS severity index was lower than in group B (p0.05). Conclusion. Long-term use of GC did not lead to a decrease in disease activity, inhibition of radiographic progression, delayed the timely administration of b/tsDMARDS and was accompanied by an increase in the multimorbid load.https://ter-arkhiv.ru/0040-3660/article/viewFile/551819/132626rheumatoid arthritisglucocorticoidsmultimorbidityadverse reactions |
| spellingShingle | Andrey V. Gordeev Elena V. Matyanova Elena A. Galushko Long-term use of glucocorticoids in patients with active rheumatoid arthritis: therapeutic "freeze frame" Терапевтический архив rheumatoid arthritis glucocorticoids multimorbidity adverse reactions |
| title | Long-term use of glucocorticoids in patients with active rheumatoid arthritis: therapeutic "freeze frame" |
| title_full | Long-term use of glucocorticoids in patients with active rheumatoid arthritis: therapeutic "freeze frame" |
| title_fullStr | Long-term use of glucocorticoids in patients with active rheumatoid arthritis: therapeutic "freeze frame" |
| title_full_unstemmed | Long-term use of glucocorticoids in patients with active rheumatoid arthritis: therapeutic "freeze frame" |
| title_short | Long-term use of glucocorticoids in patients with active rheumatoid arthritis: therapeutic "freeze frame" |
| title_sort | long term use of glucocorticoids in patients with active rheumatoid arthritis therapeutic freeze frame |
| topic | rheumatoid arthritis glucocorticoids multimorbidity adverse reactions |
| url | https://ter-arkhiv.ru/0040-3660/article/viewFile/551819/132626 |
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