Steroid Use in Early Rheumatoid Arthritis Associated with Fractures Save

The impact of systemic glucocorticoid exposure on fracture risk among new-onset rheumatoid arthritis (RA) was studied using administrative claims data detailing the treatments and outcomes of 42,127 newly diagnosed RA patients (between 2005-2012).

The vast majority (85 %) of RA patients were exposed to steroids. Although exposed and unexposed patients were demographically similar, fracture risk was significantly higher at doses <15 mg/day (5 to 9 per 1000 person-years),  ≥15 mg/day (16 per 1000 PY), and with cumulative doses ≥5400 mg (13.4 per 1000 PY). 

Adjusted fracture risk was approximately 2-fold higher at highest dose levels compared with 0 mg/day current daily dose and <675 mg cumulative dose, respectively.

Fracture risk was 29% lower at 2-6 months after discontinuation of steroids compared with ongoing use and returned to the rates of unexposed patients by 12 months.

Among younger, new-onset RA patients, fracture risk was significantly elevated at high levels of daily and cumulative dose, and was similar to unexposed patients by 12 months post-discontinuation.