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2013, vol. 19, br. 3-4, str. 81-86
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Uticaj glikokortikoida na vrednost koštane gustine kod bolesnika sa reumatoidnim artritisom
Glucocorticoids effect on the value of bone density in patients with rheumatoid arthritis
aSpecijalna bolnica za reumatske bolesti, Novi Sad bPrivatna specijalistička ordinacija za fizikalnu medicinu i rehabilitaciju Medhome, Bačka Palanka
e-adresa: tanjajankovic13@yahoo.com
Sažetak
Uvod. Reumatoidni artritis (RA) kao bolest je faktor rizika za osteoporozu. Hronična terapija glikokortikoidima (GK) dodatno doprinosi razvoju osteoporoze, utičući na promenu vrednosti koštane gustine kod bolesnika sa RA (dnevna doza, dužina primene i kumulacija leka). Cilj rada. Ispitati uticaj primene glikokortikoida na vrednost koštane gustine kod bolesnika sa RA. Metod. Ispitivanje je sprovedeno u periodu od septembra 2011. do septembra 2012. godine u Specijalnoj bolnici za reumatske bolesti u Novom Sadu na 180 bolesnika sa RA, 155 (86,1%) žena i 25 muškaraca (13,9%), srednjeg životnog doba 57 godina, prosečne dužine trajanja bolesti 8,9 godina. Svi bolesnici su bili na stabilnoj dozi pronizona prosečne vrednosti 10 mg dnevno, tokom godinu dana. Bolesnicima je na početku ispitivanja i nakon godinu dana rađen osteodenzitometrijski (DEXA) pregled. Merena je mineralna koštana gustina (BMD) na lumbalnoj kičmi (LK) i kuku, izražena u apsolutnim vrednostima (g/cm2) i u vidu T-skora. Statističke analize su rađene u programu Statistical Package for The Social Sciences 20.0. Rezultati. Pri prvom merenju, normalan DEXA nalaz imalo je 58 (32,2%) bolesnika, osteopeniju 83 (46,1%), prosečne vrednosti T-skora i BMD na LK (-1,5 SD; 0,997 g/cm2) i kuku (-1,64 SD; 0,815 g/cm2). Osteoporoza je bila prisutna kod 39 (21,7%) bolesnika sa nalazom na LK (-3,2 SD i 0,774 g/cm2) i kuku (-2,9 SD i 0,815 g/cm2). Na kontrolnom pregledu nakon godinu dana, normalnu vrednost DEXA nalaza imalo je 50 (27,8%) bolesnika, 78 (43,3%) osteopeniju, i 52 (28,9%) osteoporozu. Dobijene prosečne vrednosti T-skora i BMD kod bolesnika sa osteopenijom za LK (-1,7 SD; 0,939 g/cm2) i kuk (-1,7 SD; 0,797 g/cm2) i osteoporozom za LK (-3,3 SD; 0,761 g/cm2) i kuk (-3,08 SD; 0797 g/cm2) pokazale su značajnu statističku razliku u odnosu na vrednosti dobijene pri prvom DEXA pregledu (p<0,001). Zaključak. Primena glikokortikoida značajno utiče na smanjenje koštane gustine kod bolesnika sa RA. Zbog toga je veliki značaj prevencije, ranog dijagnostikovanja i lečenja RA, što podrazumeva redizajniranje režima terapije i skraćenje dužine terapije GK, blagovremeno uvođenje savremene terapije RA i edukaciju bolesnika radi eliminacije ostalih faktora rizika za osteoporozu.
Abstract
Introduction: Rheumatoid arthritis (RA), as a disease, is a risk factor for osteoporosis. Chronic glucocorticoid therapy (GC) is the most common cause of changes in the value of bone density in patients with rheumatoid arthritis (RA). It correlates with the dose, the length of usage and the accumulation of the drug. Objective: To examine effects of glucocorticoid therapy on bone density values in patients with RA. Method: The one-year study included 180 patients with RA, 155 women (86.1%) and 25 men (13.9%) of median age 57, with average disease duration of 8, 9 years. All patients were on a stable dose of prednisone median value 10 mg per day, during the year. Osteodensitometric (DEXA) examination was performed in all patients, at the beginning of examination and one year later. The bone mineral density (BMD) at the lumbar spine (LS) and hip was measured and expressed as absolute value (g/cm2) in the form of T-scores. Statistical analyses were done in the Statistical Package for The Sciences 20.0 program. Results: In the first measurement, 58 (32.2%) patients had normal DEXA findings, 83 (46.1%) had osteopenia with mean T-score and BMD at LS (-1.5 SD; 0.997 g/cm2) and at hip (-1.64SD, 0.815 g/cm2). Osteoporosis was present in 39 (21.7%) patients with LS finding of (-3.2 SD; 0.774 g/cm2) and hip finding of (-2.9 SD; 0.815 g/cm2). At the control after one year, normal DEXA findings were present in 50 (27.8%) patients, 78 (43.3%) had osteopenia and 52 (28.9%) had osteoporosis. The average value of T-score and BMD in patients with osteopenia for LS (-1.7SD; 0.939 g/cm2) and hip (-1.77 SD; 0.797 g/cm2) and osteoporosis for LS (-3.3SD; 0.761 g/cm2) and hip (-3.08 SD; 0.797 g/cm2) showed statistically significant difference, compared to the first values of DEXA examination (p<0.001). Conclusion: The usage of glucocorticoids in patients with RA significantly decreases the bone density. Because of this, its prevention, early diagnosis and treatment are of great importance, which would primarily entail redesigning the GC regime and patient education.
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