Scleroderma Renal Crisis and Musculoskeletal Corticosteroid Injections.

IF 2.4 4区 医学 Q2 RHEUMATOLOGY JCR: Journal of Clinical Rheumatology Pub Date : 2025-01-01 Epub Date: 2024-11-11 DOI:10.1097/RHU.0000000000002168
Maheswari Muruganandam, Eyerusalem B Akpan, Matthew K McElwee, N Suzanne Emil, Meredith C Keller, Adarsh S Vangala, Fatmah Dihowm, Sharon E Nunez, James I Gibb, Frank X O'Sullivan, Roderick A Fields, Wilmer L Sibbitt
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Abstract

Background/objective: Inflammatory arthritis frequently affects patients with systemic sclerosis (SSc) but musculoskeletal corticosteroid (MSKC) injections are often avoided due to concerns of scleroderma renal crisis (SRC). This study investigated the incidence of SRC following MSKC injections.

Methods: In a 136-SSc cohort, 46 subjects underwent a total of 330 MSKC injections each receiving a significant dosage of triamcinolone acetonide (mean, 95.2 ± 44.2 mg per injection session). Data on blood pressure (BP), serum creatinine and glucose, urine protein, and complications were obtained before and after injection from the patients' medical records.

Results: MSKC and control subjects were similar in age (MSKC: 58.9 ± 12.1 vs. 55.5 ± 14.9 years), female (MSKC: 97.8% [45/46] vs. 89.9% [81/90]), antinuclear antibody (MSKC: 71.7% [33/46] vs. 81.1% [73/90]), anti-centromere antibody (MSKC: 47.8% [22/46] vs. 37.8% [34/90]), anti-topoisomerase antibody (MSKC: 26.1% [12/46] vs. 26.7% [24/90]), and anti-RNA polymerase III antibody (MSKC: 17.4.1% [8/46] vs. 24.4% [22/90]) (all p > 0.05). Pre- and post-MSKC demonstrated nonsignificant changes in systolic BP (pre: 127 ± 22 vs. post: 127 ± 21 mm Hg, p = 1.0), diastolic BP (pre: 71 ± 13 vs. post: 71 ± 11 mm Hg, p = 1.0), creatinine (pre: 0.78 ± 0.56 vs. post: 0.76 ± 0.20 mg/dL, p = 0.64), glucose (pre: 100 ± 21 vs. post: 99 ± 24 mg/dL, p = 0.67), and urine protein-creatinine ratio (pre: 0.14 ± 0.12 vs. post: 0.12 ± 0.11 mg/mg, p = 0.41). One case of SRC with mortality occurred in the controls and none in the MSKC group. No infections, hematologic abnormalities, or tendon rupture were noted.

Conclusion: MSKC injections in established SSc are generally safe with low incidences of SRC and complications. However, it is still prudent to monitor high-risk individuals and recent-onset SSc post-MSKC injection.

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硬皮病肾危象与肌肉骨骼皮质类固醇注射。
背景/目的:炎症性关节炎经常影响系统性硬化症(SSc)患者,但由于担心硬皮病肾危象(SRC),患者通常避免注射肌肉骨骼皮质类固醇(MSKC)。本研究调查了注射 MSKC 后 SRC 的发生率:在136例SSc群组中,46名受试者共接受了330次MSKC注射,每次都接受了相当剂量的曲安奈德(triamcinolone acetonide)(平均每次95.2 ± 44.2毫克)。对注射前后的血压(BP)、血清肌酐和葡萄糖、尿蛋白以及并发症进行了回顾性分析:MSKC 和对照组受试者在年龄(MSKC:58.9 ± 12.1 岁 vs. 55.5 ± 14.9 岁)、女性(MSKC:97.8% [45/46] vs. 89.9% [81/90])、抗核抗体(MSKC:71.7% [33/46] vs. 81.1% [73/90])、抗中心粒抗体(MSKC:47.8% [22/46] vs. 37.8% [34/90])、抗拓扑异构酶抗体(MSKC:26.1% [12/46] vs. 26.7% [24/90])和抗 RNA 聚合酶 III 抗体(MSKC:17.4.1% [8/46] vs. 24.4% [22/90])(均 p > 0.05)。MSKC前后,收缩压(前:127 ± 22 vs. 后:127 ± 21 mm Hg,p = 1.0)、舒张压(前:71 ± 13 vs. 后:71 ± 11 mm Hg,p = 1.0)、肌酐(前:0.78 ± 0.56 vs. 后:0.76 ± 0.20 mg/dL,p = 0.64)、葡萄糖(前:100 ± 21 vs. 后:99 ± 24 mg/dL,p = 0.67)和尿蛋白-肌酐比值(前:0.14 ± 0.12 vs. 后:0.12 ± 0.11 mg/mg,p = 0.41)。对照组有一例 SRC 死亡病例,MSKC 组无一例。未发现感染、血液学异常或肌腱断裂:结论:对已确诊的 SSc 进行 MSKC 注射总体上是安全的,SRC 和并发症的发生率较低。结论:对已确诊的 SSc 进行 MSKC 注射总体上是安全的,SRC 和并发症的发生率较低,但仍需谨慎监测注射 MSKC 后的高危人群和新发 SSc。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.50
自引率
2.90%
发文量
228
审稿时长
4-8 weeks
期刊介绍: JCR: Journal of Clinical Rheumatology the peer-reviewed, bimonthly journal that rheumatologists asked for. Each issue contains practical information on patient care in a clinically oriented, easy-to-read format. Our commitment is to timely, relevant coverage of the topics and issues shaping current practice. We pack each issue with original articles, case reports, reviews, brief reports, expert commentary, letters to the editor, and more. This is where you''ll find the answers to tough patient management issues as well as the latest information about technological advances affecting your practice.
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