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Rheumatology 2001; 40: 1375-1383
© 2001 British Society for Rheumatology
Original Papers |
Prevalence of vertebral deformities and symptomatic vertebral fractures in corticosteroid treated patients with rheumatoid arthritis
Department of Rheumatology and Clinical Immunology, F02.127, University Medical Center, PO Box 85500, 3508 GA Utrecht,
1 Department of Rheumatology, Free University Hospital, PO Box 7057, 1007 MB Amsterdam,
2 Department of Rheumatology, University Medical Center, PO Box 9101, 6500 HB Nijmegen,
3 Department of Rheumatology, Atrium Medical Center, PO Box 4446, 6401 CX Heerlen,
4 Department of Rheumatology, Sint Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein,
5 Department of Rheumatology, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam,
6 Department of Rheumatology, Hospital Medisch Centrum Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden,
7 Department of Rheumatology, Hospital Bosch Medicentrum, Nieuwstraat 34, 5211 NL's-Hertogenbosch,
8 Department of Rheumatology, Hospital Diaconessenhuis, PO Box 90052, 5600 PD Eindhoven,
9 Julius Center for General Practice and Patient Oriented Research, University Medical Center, PO Box 85500, 3508 GA Utrecht and
10 Department of Rheumatology, Hospital Hilversum, PO Box 10016, 1201 DA Hilversum, The Netherlands
Objective. This study was designed to determine whether the prevalence of vertebral deformities in patients with rheumatoid arthritis (RA) treated with corticosteroids (Cs) is higher than in RA patients not receiving Cs therapy.
Patients and methods. This multicentre cross-sectional study included 205 patients with RA who were receiving Cs orally on a daily basis and 205 patients with RA who did not receive Cs, matched for sex and age. Vertebral deformities were scored according to the Kleerekoper method.
Results. Vertebral deformities were found in 52 (25%) patients on Cs and in 26 (13%) patients not on Cs. Sixteen (8%) patients in the group on Cs had experienced clinical manifestations of an acute vertebral fracture in the past vs only three patients (1.5%) among those not on Cs. The use of Cs tended to increase the risk of developing a vertebral deformity [adjusted odds ratio (OR) 1.56, 95% confidence interval (CI) 0.81–2.99] and symptomatic vertebral fracture (adjusted OR 1.42, 95% CI 0.24–8.32). Each 1-mg increase in the current daily Cs dose increased the risk of a vertebral deformity (adjusted OR 1.05, 95% CI 0.98–1.13) and of a symptomatic vertebral fracture (adjusted OR 1.05, 95% CI 0.89–1.24).
Conclusion. There is a higher prevalence of vertebral deformities and clinical manifestations of vertebral fractures in patients on Cs than in those not on Cs. Our data indicate that the use of Cs and each 1-mg increase in the current daily Cs dose may increase the risk of development of a vertebral deformity and symptomatic vertebral fracture in patients with RA.
KEY WORDS: Corticosteroids, Prevalence, Rheumatoid arthritis, Symptomatic vertebral fractures, Vertebral deformities.
Correspondence to: R. N. J. de Nijs, Department of Rheumatology and Clinical Immunology, F02.127, University Medical Center, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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