Background Estrogen hormone dependent osteoarthritis (EDPOA) is presented in peri-menopausal age women. Their manifestations are polyarticular pain with common co-morbidities (carpal tunnel syndrome, insomnia, fatigue, depression and fibromyalgia). Based on dual role of glucocorticoids (GC) (trophic action on the chondrocyte and anti-inflammatory effect we conducted this work.
Objectives to evaluate the efficacy and safety of low doses of GC to control both the joint pathology condition as well the co-morbidities associated with EDPOA.
Methods A prospective interventional cohort study was conducted. A hundred peri-menopausal women treated between July 2008 and July 2011 with diagnostic of EDPOA. Prednisolone at an initial dosage of 5 mgr/day was used. The patients were evaluated every month, and according to the clinical course of steroid dose it was reduced. The outcome measures used to determine response (at onset and at the end of the study) were tender joint counts, visual analogue scale (VAS) to assess pain, symptoms or signs presented or absent associated to co-morbidities (carpal tunnel syndrome, insomnia, fatigue, depression and fibromyalgia). The doses reduction or withdrawal of GC and NSAID was evaluated too. This study has been approved by the Fundaciόn Valle del Lili ethics committee. Data was analyzed using STATA version 11.0 for Windows and statistical significance was taken to be p<0.05.
Results The average age of patients in admission was 57 years (Range: 52-65). The average age of onset of the symptoms was 53.5 years (Range: 49 -61). Eighty-two patients (82%) were consuming NSAIDs at baseline, of which 23 (28.05%) were consuming unmodified and 49 (59.76%) had dose reduction at 24 weeks. Three patients (3%) had retired for improvements of joint pain. At onset the tender joint count was 27.5 (range: 20-34), and at 24 weeks was 3 (range: 1-8) (p<0.01). The VAS at onset of the study was 7 (range: 6-8), and at 24 weeks was 2 (range: 1-3) (p<0.01) (See Figure 1 and Table 2). The numbers of patients with co-morbidities were presented as follow: at onset, carpal tunnel syndrome 30 (30%), insomnia 33 (33%), fatigue 79 (79%), depression 16 (16%) and fibromyalgia 18 (18%); at 24 weeks, 11 (11%) (p<0.01), 2 (2%) (p<0.01), 11(11%) (p<0.01), 2(2%) (p<0.01) and 6 (6%) (p<0.01) respectively At a 24 weeks follow up, 44 patients (44%) had decreased GC doses, 42 (42%) had unchanged the initial dose and 4 (4%) withdrew due to improvement. Adverse effects attributed to the medication occurred in seven patients: three with hypertension de novo, two with previous hypertension showed increased blood pressure, one with osteoporotic fracture and one with diabetes mellitus de novo.
Conclusions The use of low-dose GC in patients with EDPOA can be an effective and a safe therapeutic option.
Disclosure of Interest None Declared