A RETROSPECTIVE ANALYSIS OF GLUCORTICOSTEROIDS UTILIZATIONAMONG PATIENTS WITHRHEUMATOID ARTHRITIS

Background:Glucocorticoid therapy is used widely in patients with rheumatoid arthritis(RA). Recently, treatment guidelines recommendglucorticosteroids (GCs) use in low dose and for a short time in RA. However, for many patients, it is still difficult to withdraw GCs once initiated.

Objectives: to analyzeGCs utilization in RA patients and to evaluate the effects of increasing cumulativedoses on theprevalence of potential GCs related adverse events.

Methods:we enrolled patients with RA. Corticoid exposure was defined: duration (short ≤6 months and long >6months), average daily dose (low ≤ 2.5mg, medium 2.5mg < ≤ 7.5mg and high > 7.5mg). 

Effect of increasing cumulative GCs doses on adverse events development were analyzed usingchi-square test or Fischers exact test. Regression models were used to identify the factors favoring GCs discontinuation.

Results:a total of 168 RA were included (84 patients usedbDMARDs). The median of cumulative GCs dose was 14400mg. the majority of GCs users were prescribed high doseof GCs (54.3%) for a long duration (98.7%). Skin events (71.5%) were the majorside effects. Higher cumulative GCs doses compared with lower doses had increased incidence of diabetes, cardiovascular and ophthalmologic events (p=0.04, p=0.001, p=0.02 respectively).The prevalence of RA patients having withdrawnGCs was 38.7%. It was negatively associated in multivariable regression with RA duration (OR:0.8, IC95%:0.6-0.9). Surprisingly, there was no association in logistic regression with bDMARD use. 

Conclusions:GCs were used with high dose and for a long duration for the majority of our RA patients.