Background/Purpose: Patients with rheumatoid arthritis (RA) who have muscle weakness and stiff or painful joints might be at increased risk of falls and fractures. The present study prospectively investigates correlations between decreasing dosage of glucocorticoid (GC) and the incidence of clinical fractures in patients with RA based on the five-year findings of the TOMORROW study (UMIN000003876) that started in 2010.

Methods: We evaluated anthropometric parameters, bone mineral density, disease activity, RA medication, and the incidence of clinical fractures over a period of five years in 202 patients with RA (mean age, 58.6 years; mean disease duration, 14.0 years). We also assessed the effects of adjusting GC doses on the incidence of clinical fractures over the same period in patients with RA using cox proportional hazard regression analysis.

Results: The incidence of clinical fractures in patients with RA was 0.042/person-years (py). There were 84 RA patients (41.6%) treated with GC whose incidence rate and number of clinical fractures were significantly higher than those without GC treatment (27.4% vs. 11.9%; p = 0.008; 0.063 vs. 0.012 py; p = 0.012, respectively). After adjusting for confounding factors including age, sex, smoking, and body mass index, multivariable cox proportional hazard regression analysis revealed that GC administered within the five-year period was a significant risk factor for clinical fractures (hazard ratio [HR], 2.35; 95% confidence interval [CI], 1.18 to 4.68; p = 0.015). An average of GC dose during the 5-year period of ≥ 2 mg/day increased risk for fractures in patients with RA (HR, 2.67; 95% CI, 1.06 to 6.72; p = 0.037). Although only reducing the GC dose did not decrease the risk of clinical fractures in patients with RA (HR, 0.75; 95% CI, 0.31 to 1.82; p = 0.521), risk was significantly decreased when the GC dose was reduced to zero within the five-year period (HR, 0.28; 95% CI, 0.11 to 0.72; p = 0.008).

Conclusion: Medication with GC was a significant risk factor for clinical fractures, and low GC doses (≥ 2 mg/day) are apparently significantly associated with an increased frequency of fractures among patients with RA. However, achieving freedom from GC among RA patients within five-years could decrease the risk for clinical fractures. We concluded that GC medication should be tapered to zero over a period of five years in patients after RA activity is controlled well.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/reducing-the-dosage-of-glucocorticoid-to-zero-might-decrease-risk-of-clinical-fractures-in-patients-with-rheumatoid-arthritis-five-year-findings-of-the-tomorrow-study/