Öz
Amaç
Romatoid artrit (RA), öncelikli olarak eklemleri etkileyen kronik bir otoimmün hastalık olup sıklıkla kemik kaybına yol açar. RA tedavisinde anti-enflamatuvar özellikleri nedeniyle yaygın olarak reçete edilen glukokortikoidlerin (GK), düşük dozda kullanıldıklarında kemik sağlığı üzerindeki etkileri tartışmalıdır. Bu çalışma, RA hastalarında düşük doz GK kullanımının kemik mineral yoğunluğu (KMY) ve osteoporoz (OP) riski üzerindeki etkilerini değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntem
Bu çalışma, Erciyes Üniversitesi Tıp Fakültesi Romatoloji Polikliniği’nde yürütüldü. Çalışmaya 74 RA hastası ve 39 sağlıklı kontrol bireyi (≥18 yaş) dahil edildi. Katılımcıların demografik verileri [yaş, cinsiyet, vücut kitle indeksi (VKİ)] ve klinik değerlendirmeleri (hastalık aktivite skoru, RA yaşam kalitesi ölçeği) standart bir form aracılığıyla kaydedildi.
Bulgular
RA hastalarının, sağlıklı kontrollere kıyasla lomber omurga ve femur bölgelerinde anlamlı derecede daha düşük KMY ve T-skorlarına sahip olduğu saptandı (p<0,001). RA hastaları arasında kortikosteroid kullananlarda VKİ (p=0,012) ve femur T-skorları (p=0,011) daha düşük bulunurken, diğer klinik veya laboratuvar parametrelerde anlamlı bir fark gözlenmedi. Lojistik regresyon analizine göre yaş, OP için bağımsız bir risk faktörü olarak belirlendi [risk oranı (RO)=1,13, %95 güven aralığı (GA): 1,04-1,24, p=0,005] ve düşük doz GK kullanımı OP riskiyle negatif yönde ilişkili bulundu (RO=0,36, %95 GA: 0,11-0,99, p=0,048).
Sonuç
Bu çalışma, düşük doz GK tedavisinin RA hastalarında OP riskini artırmadığı ve bazı durumlarda bu riski azaltabileceğini göstermektedir. Yaş, OP açısından temel belirleyicilerden biri olarak öne çıkmakta ve kemik sağlığını korumada kişiselleştirilmiş tedavi stratejilerinin önemini vurgulamaktadır.
Anahtar Kelimeler: Romatoid artrit, glukokortikoidler, düşük doz kortikosteroidler, kemik mineral yoğunluğu, osteoporoz
Kaynakça
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