title: Incident comorbidity among patients with rheumatoid arthritis treated or not with low-dose glucocorticoids: a retrospective study.
abstract: OBJECTIVE
  To assess the prevalence of comorbidity in a cohort of patients with rheumatoid arthritis (RA), treated or not with low-dose glucocorticoids (GC) and who have been followed for at least 10 years.
  
  
  METHODS
  This was a retrospective study by review of medical records.
  
  
  RESULTS
  We identified 365 patients: 297 (81.3%) were GC users (4-6 mg methylprednisolone daily) and 68 (18.7%) were nonusers. We found that fragility fractures occurred in 18.2% of GC users and in 6.0% of GC nonusers (p < 0.02); arterial hypertension in 32.3% of GC users and in 10.4% of GC nonusers (p < 0.0005); acute myocardial infarction in 13.1% of GC users and in 1.5% of the nonusers (p < 0.01). Prevalence of diabetes mellitus, cataract, and infections was comparable. We divided GC users into groups of different duration of GC therapy: < 2, 2-5, and > 5 years; the mean duration of GC treatment was 1.3 ± 0.5, 3.6 ± 1.1, and 12.1 ± 5.1 years, respectively. GC treatment for > 5 years was associated with significantly higher prevalence of fragility fractures (26.6%; p < 0.001 vs the other groups), arterial hypertension (36.7%; p < 0.0002 vs nonusers and GC users < 2 years), myocardial infarction (16.1%; p < 0.01 vs nonusers), and infections (9.7%; p < 0.005 vs the other groups). GC treatment for 2-5 years was associated with a significantly higher prevalence of arterial hypertension (30.0%; p < 0.01) compared to nonusers.
  
  
  CONCLUSIONS
  Patients with RA treated with low-dose GC compared to patients never treated with GC show a higher prevalence of fractures, arterial hypertension, myocardial infarction, and serious infections, especially after 5 years of GC treatment. The high prevalence of myocardial infarction and fractures in patients with RA suggests that a more accurate identification of risk factors and prevention measures should be adopted when longterm GC treatment is needed.
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy. mmazzant@int.med.unipi.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Mazzantini
authors.forename: Rosaria
authors.initials: R
authors.lastname: Talarico
authors.forename: Marica
authors.initials: M
authors.lastname: Doveri
authors.forename: Arianna
authors.initials: A
authors.lastname: Consensi
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Cazzato
authors.forename: Laura
authors.initials: L
authors.lastname: Bazzichi
authors.forename: Stefano
authors.initials: S
authors.lastname: Bombardieri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D005938:Glucocorticoids