四年左右的朋友，如今现状如何

大人物

补充一点：其结论如其标题，认为小剂量激素控制的RA活动，可能不代表真正的将RA活动降低。。。。大意哈

紫色风铃

我理解为：即使小剂量激素的长期应用从综合健康功能上讲并不优于不用使用激素着。也就是不提倡激素的使用。但我觉得长期肿痛不消着使用激素能快速消肿，也是不错的的选择！

大人物

注意原文和散木的意思。

我特意把那几个字弄黑体了。

现在讨论的对象都是病情活动被降至很低的了。讨论的是这些人用小剂量激素维持还是不用激素。有别于讨论处于活动期的患者是否需要激素治疗。

springhoper

谢谢大人物的翻译。很到位。
因我的打字速度太慢（小时候没好好学拼音），所以很难全面写出来。我可以提供全文， 不知大人物 等英文高手可帮助翻译。多谢！！！

springhoper

小剂量激素长期服用（》１０年）会增加死亡率。　（21% ／４５％）

Mortality in Patients with Rheumatoid Arthritis Treated with Low-Dose Oral Glucocorticoids. A Population-Based Cohort Study

SUSANNA SIHVONEN, MARKKU KORPELA, JUKKA MUSTONEN, HEINI HUHTALA, KRISTA KARSTILA, and AMOS PASTERNACK

ABSTRACT.

Objective. To evaluate mortality and causes of death in patients with rheumatoid arthritis (RA) treated with low-dose oral glucocorticoids.

Methods. Mortality was analyzed in population-based data of 604 patients with RA. In the original study in 1988, state of general health, severity of RA, and treatment including the use of oral glucocorticoids were recorded. In 1999 vital status and causes of death were evaluated. Mortality in patients with RA who had not received glucocorticoids (Group A, n = 209) was compared to that in patients treated with glucocorticoids for less than 10 years (Group B, n = 276) or for more than 10 years (Group C, n = 119).

Results. From onset of RA to 1999, 395 (65%) patients had been treated with oral glucocorticoids. In 1999 a total of 160 (26%) patients had died, 23% of patients in Group A, 21% in Group B, and 45% in Group C. In multivariate Cox regression analysis, male sex (hazard ratio 2.50; 95% CI 1.74–3.59), impaired functional capacity by Health Assessment Questionnaire (HR 2.11; 95% CI 1.65–2.96), heart failure (HR 1.96; 95% CI 1.36–2.84), and diabetes (HR 1.87; 95% CI 1.17–3.01) predicted increased mortality. In the same analysis glucocorticoid treatment for 1 year increased the mortality risk by 14% (HR 1.14; 95% CI 0.98–1.27, p = 0.057) and treatment over 10 years by 69% (HR 1.69; 95% CI 1.12–2.56, p = 0.011) compared to RA patients without treatment. The major cause of death was cardiovascular disease in all groups, but infections and intestinal perforations due to amyloidosis were more frequent in patients with long-lasting glucocorticoid therapy. Lymphomas were more frequent in all patients treated with glucocorticoids (Groups B and C) than in those not receiving glucocorticoids.

Conclusion. Patients with RA treated with low-dose oral glucocorticoids for more than 10 years had increased mortality compared to those who did not receive glucocorticoids or whose duration of treatment was less than 10 years. The increased mortality was related mainly to infections and complications caused by systemic amyloidosis. (First Release Aug 1 2006; J Rheumatol 2006;33:1740–6)

springhoper

争议？？？？　小剂量激素长期服用（》１０年）会增加死亡率。　（21% ／４５％）

美国新闻世界报道文章认为：　女《７。５mg/day ,　男《１０mg/day 是安全的。最后总结认为：　因为激素的副作用，　最好是短期应用，且密切关注副作用。但怕死是没比要的。


U.S. News & World Report：
Living With Pain: A Scare for Arthritis Patients
By Josh Fischman
Posted 10/11/06

Headlines like "Death risk linked to steroid use for arthritis" are not comforting, since most of the 2 million rheumatoid arthritis patients in this country have been on steroid pills such as prednisone at one point or another. Yet that's the headline Reuters used last week to announce a new study hinting that RA patients who used prednisone had a higher death rate than those who didn't; the story was also picked up by Scientific American's website and a TV station as far away as New Zealand.

Yet news headlines like this are way overblown. "We've all known that corticosteroids like prednisone are two-edged swords," says Roland Moskowitz, a rheumatologist at Case Western Reserve University School of Medicine and a leading arthritis researcher. "They do have side effects. But used carefully they are safe, and they are really valuable medications." The drugs damp down inflammation, a hallmark RA symptom.
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The study, conducted by researchers in Finland and published last month in the Journal of Rheumatology, focused on 600 RA patients, 65 percent of whom had been treated with corticosteroids. Compared with those who didn't get the drugs, corticosteroid patients' risk of death was 14 percent higher after one year and 69 percent higher after 10 years. Causes of death were mostly related to infections.

Scary numbers, but steroids may not be the only reason behind them. In their paper, the Finnish researchers caution that other factors could account for the deaths they observed. "It's the sickest patients who get more corticosteroids, and since they were sicker to start with, you'd expect more deaths," says Moskowitz. "Plus they were being treated with many other drugs, so it's impossible to single out the steroids as responsible for the deaths. It could have been other drugs, and it could have been their greater degree of illness."

Other studies, in fact, have shown that steroids like prednisone are safe in low doses–less than 7.5 milligrams per day for women and under 10 milligrams for men. "Steroids are very important as 'bridge' therapies" to help patients while they wait for other drugs to kick in, Moskowitz says. "If a patient is seriously flaring with inflammation, you put them on low-dose prednisone for three months until other drugs, such as methotrexate, build up in their bodies enough to have an effect."

Steroids can cause side effects like hypertension and osteoporosis, so they are best used for short periods. And people on them need to be carefully watched. But fear of death as a major side effect is premature.

springhoper

激素是桥－－－而不是路。（sometimes not always , some days not every day )

springhoper

2009 年六月欧洲RA年会－－关于减少RA治疗副作用问题。很多热点问题都在幻等片，　如激素，　流感疫苗，。。。。。

http://www.naccme.com/public/200 ... umatic-Diseases.pdf

大人物

楼上很专业：）

其实你在每个原文前面那些简略的汉字说明，概括都很好了。

散木

谢谢两位超强人！辛苦啦！大人物对我的意思理解很到位。

面对副作用，是我们可能比药物治疗更重视的话题。现在有一种认识，就是低剂量药物控制下的低类风湿活动，并不是追求完全的控制。毋庸置疑，医生对“如果部分类风湿患者，需要终身服用药物治疗，那些药物的副作用将是不可回避的问题”的担忧。这也是我最担心的事情，但是因为没有答案，很久以来，我并不想把它公开的表达出来。现在，遇到大人物、springhoper这样的超强人，我就在此说出来。我们也许没有答案，可是，如果从比较专业、理智的方面去分析，应该比纯粹的害怕、担心好。

低剂量的激素，具体到小于4mg卓美乐，可不可以降低免疫抑制剂的使用量？前提自然是类风湿的合理控制。激素虽然是化学药物，说到底也是人体分泌的一种激素。现在公认的是激素治疗是“桥”，在控制类风湿比较重的活动中使用，最后都要求完全撤药。可是，我们也会发现，一些人在低剂量（半片甚至四分之一强的松）的时候，撤药比较难。这个时候，激素和免疫抑制剂到底哪个更适合？

springhoper网址提供的仍然是英文啊，大人物，多辛苦辛苦吧。