While low-dose oral glucocorticoids (GCs) are recommended in the management of early arthritis, their impact on mortality is unclear. The aim of this study is to evaluate the effect of GCs on mortality in patients with early arthritis, by linking clinical and administrative databases. The study included patients with new-onset rheumatoid arthritis (RA) or undifferentiated arthritis (2005–2010), who received DMARDs (MTX in RA or UA with poor prognosis, hydroxychloroquine in UA) and were alive at the second year of follow-up. Low-dose GCs could be prescribed. Clinical and administrative data were linked from Administrative Health Databases (AHD) of the corresponding province, which provided us with information on drug delivery, comorbidities, hospitalization, and mortality. The effect of GCs in the first year was defined using a dichotomous variable or a 3-level categorization (not delivered, ≤7.5 mg/day, or >7.5 mg/day of prednisone) on all-cause mortality, assessed with Cox regression, either crude or adjusted for age, gender, Charlson Comorbidity Index (CCI) or single comorbidities, ACPA, HAQ, and MTX in the first year. A secondary analysis of the effect of GCs on related hospitalizations (for cardiovascular events, diabetes, serious infections, osteoporotic fractures) was also carried. Four hundred forty-nine patients were enrolled (mean age 58.59, RA 65.03%) of which 51 (11.36%) died during the study. The median (IQR) follow-up was equal to 103.91 (88.03–126.71) months. Treatments with GCs were formally prescribed to 198 patients (44.10%) at ≤7.5 mg/day, although by the end of the study such treatments were received by 257 patients (57.24%); 88 patients (19.6%) were treated with GCs at >7.5 mg/day. In adjusted analyses, the GC delivery (HR, 95% CI 1.35 (0.74, 2.47)) did not significantly predict mortality — both at a low (HR, 95% CI 1.41 (0.73, 2.71)) and at a high (HR, 95% CI 1.23 (0.52, 2.92)) dosage. When “all-cause hospitalization” was used as an outcome, the analysis did not show a difference between patients receiving GC and patients not receiving GC. In patients with early inflammatory arthritis, the initial GC dose was higher than that prescribed by rheumatologists; however, on background treatment with DMARDs, GC treatments did not seem to increase mortality and hospitalizations.

中文翻译：

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初始糖皮质激素联合用药对早期炎症性关节炎死亡率和住院率的影响：通过临床和管理数据库的记录链接进行的调查

虽然在早期关节炎的管理中推荐使用低剂量口服糖皮质激素 (GCs)，但它们对死亡率的影响尚不清楚。本研究的目的是通过链接临床和管理数据库来评估 GCs 对早期关节炎患者死亡率的影响。该研究包括新发类风湿性关节炎 (RA) 或未分化关节炎 (2005-2010) 的患者，他们接受了 DMARDs（RA 或 UA 中的 MTX，预后不良，UA 中的羟氯喹）并且在随访的第二年仍然存活. 可以开出低剂量的 GC。临床和行政数据来自相应省份的行政健康数据库 (AHD)，为我们提供了有关药物输送、合并症、住院和死亡率的信息。第一年 GC 对全因死亡率的影响使用二分变量或 3 级分类（未交付、≤7.5 mg/天或 >7.5 mg/天泼尼松）定义，采用 Cox 回归评估，第一年根据年龄、性别、查尔森合并症指数 (CCI) 或单一合并症、ACPA、HAQ 和 MTX 进行粗略或调整。还对 GC 对相关住院（心血管事件、糖尿病、严重感染、骨质疏松性骨折）的影响进行了二次分析。共招募了 449 名患者（平均年龄 58.59，RA 65.03%），其中 51 名（11.36%）在研究期间死亡。中位 (IQR) 随访时间等于 103.91 (88.03–126.71) 个月。198 名患者 (44.10%) 正式接受 GCs 治疗，剂量≤7.5 mg/天，尽管在研究结束时有 257 名患者（57.24%）接受了此类治疗；88 名患者 (19.6%) 接受了 >7.5 mg/天的 GCs 治疗。在调整后的分析中，GC 递送（HR，95% CI 1.35 (0.74, 2.47)）没有显着预测死亡率——无论是在低（HR，95% CI 1.41（0.73，2.71））和高（HR， 95% CI 1.23 (0.52, 2.92)) 剂量。当使用“全因住院”作为结果时，分析并未显示接受 GC 的患者与未接受 GC 的患者之间存在差异。在患有早期炎症性关节炎的患者中，初始 GC 剂量高于风湿病医师的处方；然而，在使用 DMARD 进行背景治疗时，GC 治疗似乎并未增加死亡率和住院率。在调整后的分析中，GC 递送（HR，95% CI 1.35 (0.74, 2.47)）没有显着预测死亡率——无论是在低（HR，95% CI 1.41（0.73，2.71））和高（HR， 95% CI 1.23 (0.52, 2.92)) 剂量。当使用“全因住院”作为结果时，分析并未显示接受 GC 的患者与未接受 GC 的患者之间存在差异。在患有早期炎症性关节炎的患者中，初始 GC 剂量高于风湿病医师的处方；然而，在使用 DMARD 进行背景治疗时，GC 治疗似乎并未增加死亡率和住院率。在调整后的分析中，GC 递送（HR，95% CI 1.35 (0.74, 2.47)）没有显着预测死亡率——无论是在低（HR，95% CI 1.41（0.73，2.71））和高（HR， 95% CI 1.23 (0.52, 2.92)) 剂量。当使用“全因住院”作为结果时，分析并未显示接受 GC 的患者与未接受 GC 的患者之间存在差异。在患有早期炎症性关节炎的患者中，初始 GC 剂量高于风湿病医师的处方；然而，在使用 DMARD 进行背景治疗时，GC 治疗似乎并未增加死亡率和住院率。分析未显示接受 GC 的患者和未接受 GC 的患者之间的差异。在患有早期炎症性关节炎的患者中，初始 GC 剂量高于风湿病医师的处方；然而，在使用 DMARD 进行背景治疗时，GC 治疗似乎并未增加死亡率和住院率。分析未显示接受 GC 的患者和未接受 GC 的患者之间的差异。在患有早期炎症性关节炎的患者中，初始 GC 剂量高于风湿病医师的处方；然而，在使用 DMARD 进行背景治疗时，GC 治疗似乎并未增加死亡率和住院率。