VERTEBRAL FRACTURES IN PATIENTS WITH RHEUMATOID-ARTHRITIS TREATED WITH CORTICOSTEROIDS

Objectives: To examine the relationship between roentgenological defor mities of the vertebral column and clinical manifestations of vertebra l fractures in patients with RA, treated with glucocorticosteroids (Cs ). Methods: In all outpatients of Utrecht University Hospital with RA, who were currently using Cs (n = 52), roentgenograms of the thoracic and lumbar vertebral column were taken. Roentgenological deformities w ere scored a vue using the Kleerekoper scare, and quantitatively using the Heidelberg and Utrecht scoring methods. Clinical manifestation of a vertebral fracture was defined as a vertebral deformity lending to prescription of therapy: bedrest and/or analgesics. Clinical manifesta tions of fractures were also recorded in a control group of 55 RA pati ents not on Cs, matched for age and gender. Results: The prevalence of vertebral deformities in the Cs-treated RA patients, assessed with th e Kleerekoper score, was 58% (30 of 52 patients). In 7 of the Cs-treat ed patients clinical manifestations of a vertebral fracture were prese nt, versus 1 in the control group (p = 0.03). No significant correlati on between the 3 deformity scores and the cumulative dose of Cs was fo und. No (inverse) correlation between serum osteocalcin and the daily dosage of prednisone was found. Conclusion: Corticosteroids in active RA are associated with fractures, even when low doses are used: the pr evalence of vertebral deformities (58%) in the Cs-treated RA patients was much higher than the frequency in postmenopausal women of the same age reported in the literature, and the reported incidence of clinica lly manifestations of vertebral fractures was higher in the Cs-treated RA patients than in the control group of RA-patients not treated with Cs.