Biyolojik Tedavi Çağında Romatoid Artrit Tedavisinde Glukokorttikoidler ve Nonsteroid Antiinflamatuvar İlaçların Yeri Nedir?

Öz

Bu çalışma, romatoid artrit (RA) hastalarında steroid olmayan antiinflamatuar ilaç (NSAID) ve glukokortikoid (GC) kullanım sıklığını ve hastalık aktivitesiyle ilişkisini değerlendirmeyi amaçlamıştır. 2010 Avrupa Romatizma Birliği (EULAR) RA sınıflandırma kriterlerini karşılayan toplam 686 hasta çalışmaya dahil edilmiştir. Hastalar semptomatik tedaviye maruz kalmalarına göre dört gruba ayrılmıştır: NSAID/GC kullanımı yok, sadece GC kullanımı, sadece NSAID kullanımı ve NSAID ve GC kombinasyonu kullanımı. Hastalık aktivitesi ve fonksiyonel durum DAS28, HAQ, VAS ve inflamatuar belirteçler kullanılarak değerlendirilmiştir. Gruplar arasında hastalık süresi, DAS28, HAQ, VAS ve CRP düzeyleri açısından anlamlı farklılıklar gözlemlenmiştir (p < 0,05). NSAID ve GC kombinasyonu kullanan grup, hastaların en büyük oranını temsil etmiştir. Romatoid faktör (RF) ve anti-CCP pozitiflik oranları gruplar arasında anlamlı farklılık göstermedi. Hastaların çoğu ciddi yan etkiler bildirmedi; en sık bildirilen yan etkiler gastrointestinal semptomlar ve kilo artışıydı. Bu gerçek dünya kohortunda, biyolojik tedavilerin yaygın olarak bulunmasına rağmen semptomatik tedaviler yaygın olarak kullanılmaya devam etti. Kombine NSAID ve GC kullanımı, hastalık aktivitesi ölçümlerinde farklılıklarla ilişkilendirildi; ancak çalışmanın gözlemsel tasarımı nedensel çıkarım yapmayı engellemektedir. Semptomatik tedavilerin modern RA yönetimindeki rolünü daha iyi tanımlamak için kümülatif ilaç maruziyetini ve uzun vadeli sonuçları değerlendiren prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Glukokortikoidler
• nonsteroidal antiinflamatuar ilaçlar
• romatoid artrit.

Where do Glucocorticoids and Nonsteroidal Anti-Inflammatory Drugs Stand in the Treatment of Rheumatoid Arthritis in The Biologic Era?

Öz

This study aimed to evaluate the frequency of nonsteroidal anti-inflammatory drug (NSAID) and glucocorticoid (GC) use and their association with disease activity in patients with rheumatoid arthritis (RA). A total of 686 patients fulfilling the 2010 European League Against Rheumatism (EULAR) classification criteria for RA were included. Patients were categorized into four groups according to symptomatic therapy exposure: no NSAID/GC use, GC use only, NSAID use only, and combined NSAID and GC use. Disease activity and functional status were assessed using DAS28, HAQ, VAS, and inflammatory markers. Significant differences were observed among the groups with respect to disease duration, DAS28, HAQ, VAS, and CRP levels (p < 0.05). The combined NSAID and GC group represented the largest proportion of patients. Rheumatoid factor (RF) and anti-CCP positivity rates did not differ significantly between groups. Most patients did not report severe adverse events, with gastrointestinal symptoms and weight gain being the most frequently reported side effects. In this real-world cohort, symptomatic therapies remained commonly used despite the widespread availability of biologic treatments. Combined NSAID and GC use was associated with differences in disease activity measures; however, the observational design of the study precludes causal inference. Prospective studies evaluating cumulative drug exposure and long-term outcomes are needed to better define the role of symptomatic therapies in modern RA management.

Anahtar Kelimeler

• Glucocorticoids
• nonsteroidal anti-inflammatory drugs
• rheumatoid arthritis.

Kaynakça

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