RESUMO
OBJECTIVE: To evaluate whether treating patients with very early inflammatory polyarthritis (IP) with a 3-week course of intramuscular (IM) methylprednisolone acetate may postpone the need for disease-modifying antirheumatic drugs (DMARDs) and prevent IP from evolving into rheumatoid arthritis (RA). METHODS: Patients with very early IP (4-10 weeks' duration) were randomised to receive three injections of either 80 mg IM methylprednisolone acetate or placebo, given at weekly intervals. Assessments were monthly until 6 months after the first injection, and then concluded at 12 months. The primary outcome was the need to start DMARDs by the 6-month assessment. Secondary outcomes included disease activity and final clinical diagnosis by the rheumatologist at 12 months. RESULTS: Patients in the placebo group (76%) were more likely to need DMARDs during the first 6 months of the trial than patients in the glucocorticoid group (61%) (adjusted OR = 2.11, 95% CI 1.16 to 3.85, p = 0.015). Disease activity did not differ between the two groups at 12 months, probably because many patients in the placebo group started DMARDs early in the study. After 12 months, the arthritis had resolved without the need for DMARDs in 9.9% (11/111) of the patients in the placebo group and in 19.8% (22/111) in the glucocorticoid-treated group (adjusted OR = 0.42, 95% CI 0.18 to 0.99, p = 0.048). CONCLUSION: Treatment of patients with very early IP with IM methylprednisolone acetate appears to postpone the prescription of DMARDs and prevent one in 10 patients from progressing into RA.
Assuntos
Anti-Inflamatórios/administração & dosagem , Antirreumáticos/administração & dosagem , Artrite/tratamento farmacológico , Metilprednisolona/análogos & derivados , Anti-Inflamatórios/efeitos adversos , Antirreumáticos/efeitos adversos , Quimioterapia Combinada , Métodos Epidemiológicos , Feminino , Humanos , Injeções Intramusculares , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Acetato de Metilprednisolona , Pessoa de Meia-IdadeAssuntos
Cálcio/urina , Creatina/urina , Fósforo/urina , Neoplasias Cutâneas/urina , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Proteínas Sanguíneas/metabolismo , Hipercalcemia/metabolismo , Hiperparatireoidismo/metabolismo , Adolescente , Adulto , Cálcio/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Hipercalcemia/diagnóstico , Hiperparatireoidismo/diagnóstico , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/farmacologia , Ligação ProteicaAssuntos
Fosfatase Alcalina/sangue , Temperatura Alta , Isoenzimas/sangue , Adolescente , Adulto , Fatores Etários , Bile/enzimologia , Doenças Ósseas/enzimologia , Osso e Ossos/enzimologia , Ensaios Enzimáticos Clínicos , Estabilidade de Medicamentos , Feminino , Humanos , Fígado/enzimologia , Hepatopatias/enzimologia , Masculino , Triagem Multifásica , Placenta/enzimologia , Gravidez , Trometamina , ÁguaRESUMO
Calcium metabolism was studied in four patients who had undergone renal transplantation from eight to 19 months previously. The studies included conventional biochemical and radiological parameters, undecalcified bone histology and metabolic balances. The only abnormality found was biochemical and histologic evidence of mild hyperparathyroidism. All patients were in approximate calcium balance, and there was no evidence of osteoporosis, osteomalacia or osteitis fibrosa. It is suggested that transplantation patients with stable, well functioning grafts and normal biochemical and radiologic parameters are unlikely to have or to be at risk of developing metabolic bone disease.