title: A long-term, observational cohort study on the safety of low-dose glucocorticoids in ankylosing spondylitis: adverse events and effects on bone mineral density, blood lipid and glucose levels and body mass index.
abstract: OBJECTIVE
  This study aimed to investigate the risk of adverse events and effects on bone mineral density (BMD), blood lipid and glucose levels and body mass index (BMI) of low-dose glucocorticoid (GC) treatment in ankylosing spondylitis.
  
  
  METHODS
  We performed a retrospective, observational cohort study. Adverse effects were compared between GC users and non-GC users, and we analysed differences in the duration of GC exposure (no GC exposure, <6 months, 6 months to 2 years and >2 years).
  
  
  METHODS
  Outpatient clinic in a tertiary general hospital in China, rheumatology follow-up visits over the past 30 years.
  
  
  METHODS
  We included 830 patients with ankylosing spondylitis who were followed up for at least 6 months without a previous history or current complications of active gastrointestinal problems, hypertension, psychiatric or mental problems, diabetes mellitus, tuberculosis and hepatitis. The median follow-up time was 1.6 years (range 0.5-15 years, a total of 1801 patient-years).
  
  
  RESULTS
  A total of 555 (66.9%) patients were treated with low-dose GCs, and the median cumulative duration of GC therapy was 1.3 years (range 0.1-8.5 years). Dermatological incidents, including acne, bruisability and cutaneous infections, were the most common adverse events, with a cumulative incidence rate of 5.4% (22.2 events per 1000 patient-years), followed by a puffy and rounded face (1.6%), symptoms of weight gain (1.1%) and serious infections (1.0%). The rates of all other types of adverse events were less than 1%. The GC groups (GC users and non-GC users) and the duration of GC therapy were not associated with the frequency of low BMD, dyslipidaemia, hyperglycaemia or obesity (p<0.05).
  
  
  CONCLUSIONS
  Adverse events during long-term treatment of low-dose GCs are limited. Low-dose GCs do not have an adverse effect on BMD, blood lipid and glucose levels and BMI.
authors.affiliation: Department of Rheumatology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Yu-Ping
authors.initials: YP
authors.lastname: Zhang
authors.affiliation: Department of Rheumatology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China Research Unit of Rheumatology, Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Gong
authors.affiliation: Department of Rheumatology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China Research Unit of Rheumatology, Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Qing Yu
authors.initials: QY
authors.lastname: Zeng
authors.affiliation: Department of Rheumatology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Zhi-Duo
authors.initials: ZD
authors.lastname: Hou
authors.affiliation: Department of Rheumatology, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Zheng-Yu
authors.initials: ZY
authors.lastname: Xiao
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism; D002681:China; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007239:Infections / Q000209:etiology; D008055:Lipids / Q000097:blood*; D008159:Lumbar Vertebrae / Q000378:metabolism; D008297:Male; D010024:Osteoporosis; D012189:Retrospective Studies; D012871:Skin Diseases / Q000209:etiology; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D015430:Weight Gain / Q000187:drug effects; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D005938:Glucocorticoids; D008055:Lipids
keywords: Glucocorticoids; ankylosing spondylitis; bone density; lipids