| Objective: To evaluate the significance of low dose glucocorticoids (GCs) in the treatment of ankylosing spondylitis (AS), stressing on: (1) Does low dose GCs exert rapid anti-inflammatory effects on AS ? (2) The safety of low dose GCs treatment, such as its impact on BMD, body weight, fasting glucose, serum lipids and the incidence of other adverse effects. (3) When can the low dose treatment be withdrawn ?Methods: 260 cases of consecutive AS during the years of 1999-2009 who have been followed up for more than 0.5 years were enrolled. Clinical, laboratorial data and the results of follow-up were collected and analyzed.Results: Mean age of the 260 patients was 26.9±9.9 years , mean disease duration was 5.9±5.6 years. Among the 260 cases, 195 cases were treated with low dose GCs and 65 cases were treated without low dose GCs. The mean cumulative dose of GCs was 6.3±5.1 g, the mean cumulative duration of GC therapy was 733±586 days, and the mean daily GC dose was 8.7±1.5 mg. All patients were also treated with DMARDs, NSAIDs quaque nocte, and anti-osteoporotic drugs.Among the 132 patients treated with low dose GCs at the beginning of treatment, the rate of symptom remission was 92.4% at the first return visit(visit interval 18 days±12). No significant difference was revealed comparing with that in patients treated without GCs (93.5%). However, the patients treated with low dose GCs had significantly longer morning stiffness duration, higher BASDAI scale and proportion of enthesitis at baseline compared to those treated without GCs. Improvement at the first return visit after the low dose GCs treatment had been noted in most clinical parameters, including pain at night, BASDAI, BASFI, ESR, CRP and spinal flexion. 63 patients withdrew the low dose GCs treatment after 366 days (median), and 16 of them experienced a relapse of symptoms. After reusing low dose GCs, 13 of the 16 cases experienced symptoms remission again, and the responses of the other 3 cases were unknown. The level of CRP of these 16 patients was significantly higher than that of the patients without relapse of symptoms (P=0.016) at the time when the low dose GCs treamtment was withdrew.Data of BMD in 79 patients treated with low dose GCs and 11 patients treated without GCs were analyzed. At the end point, BMD significantly increased at lumbar spine, forearm and femur in all of the patients. The prevalence of osteopenia and OP didn't change in the follow-up. The level of fasting glucose of 58 patients treated with low dose GCs was followed up. Among these 58 cases, the level of fasting glucose of 2 cases slightly increased during the low dose GCs treatment, which had returned to normal at the end of follow-up. The level of serum lipids was monitoring in 16 patients, of those the level was normal before the low dose GCs treatment. During the low dose GCs treatment, the level of serum lipids of 3 cases was slightly abnormal. Among these 3 patients, the serum lipids level of 2 cases returned to normal at the end of follow-up and the other 1 case remained slightly abnormal. Adverse drug reaction occurred in 36 cases of low dose GCs treated patients, including epigastric discomfort(8.7%, 17 cases), body weight gain(2.1%, 4 cases), acne(2.1%, 4 cases), frequent upper respiratory tract infection(2.6%, 5 cases), skin infection(2.1%, 4 cases), headache(0.5%, 1 case) and eyelid edema(0.5%, 1 case).Conclusion: Low dose GCs is of benefit to symptoms remission, signs and laboratory measurements improving in AS patients. Some patients experienced symptom relapse if low dose GCs treatment was withdrawn. Disease activity should be evaluated before stoping the low dose GCs therapy. Long-term treatment of low dose GCs is relatively safe, without obvious adverse effects on BMD, body weight, fasting glucose, and serum lipids. |
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