編譯者：韓青，西京醫院臨床免疫科

目 的：

脊柱關節炎（SpA）由於與潛在的炎症引起的心肌梗塞（MI）風險增加有關，且可能由某些非甾體抗炎藥（NSAID）等藥物引起。我們試圖描述接受過NSAID治療的SpA患者的MI風險，並比較SpA和骨關節炎（OA）患者的風險模式。

方 法：

使用健康改善網路（THIN）進行病例對照研究。包含SpA或OA >1種NSAID處方藥並無心肌梗死病史。在每個隊列中，我們將每個MI病例與沒有MI的病例進行對照匹配。NSAID的使用分類為：（a）當前（處方日期在指數日期前0-180天），（b）最近（181-365天）或（c）長期（> 365天）。我們進行了條件回歸分析，比較當前或近期NSAID使用相對長期使用，特別考慮雙氯芬酸和萘普生發生MI的幾率。

結 果：

在8140例SpA隊列和244339例OA隊列中，分別有115和6287例MI病例。目前在SpA中使用雙氯芬酸與MI相關，OR為3.32（95％CI1.57-7.03）。使用萘普生MI無關（OR 1.19,95％CI 0.53至2.68）。SpA /雙氯芬酸相對於OA /雙氯芬酸的OR的比率為2.64（95％CI 1.24至5.58）。

結 論：

目前雙氯芬酸使用者中SpA的MI風險增加，但不是萘普生。SpA中雙氯芬酸的MI風險似乎與OA不同。

參考文獻：

Risk of myocardial infarction with use ofselected non-steroidal anti-inflammatory drugs in patients withspondyloarthritis and osteoarthritis.

Dubreuil M^1,2,Louie-Gao Q¹,Peloquin CE¹,Choi HK³,Zhang Y¹,Neogi T¹.

Abstract

OBJECTIVES:

Spondyloarthritis (SpA) is associated with anincreased risk of myocardial infarction (MI) due to underlying inflammation andpossibly due to medications such as certain non-steroidal anti-inflammatorydrugs (NSAIDs). We sought to describe MI risk among patients with SpA who wereprescribed NSAIDs, and to compare the pattern of risk in SpA with that inosteoarthritis (OA).

METHODS:

Nested case-control studies were performedusing The Health Improvement Network (THIN). Underlying cohorts included adultswith incident SpA or OA who had>1 NSAID prescription and no history ofMI. Within each cohort, we matched each MI case to four controls without MI.NSAID use was categorised as: (a) current (prescription date 0-180 days priorto index date), (b) recent (181-365 days) or (c) remote (>365 days). Weperformed conditional logistic regression to compare the odds of current orrecent NSAID use relative to remote use of any NSAID, considering diclofenacand naproxen specifically.

RESULTS:

Within the SpA cohort of 8140 and the OAcohort of 244 339, there were 115 and 6287 MI cases, respectively. Afteradjustment, current diclofenac use in SpA was associated with an OR of 3.32(95% CI 1.57 to 7.03) for MI. Naproxen was not associated with any increase(adjusted OR 1.19, 95% CI 0.53 to 2.68). A ratio of ORs for SpA/diclofenacrelative to OA/diclofenac was 2.64 (95% CI 1.24 to 5.58).

CONCLUSIONS:

MI risk in SpA is increased among currentusers of diclofenac, but not naproxen. The MI risk with diclofenac in SpAappears to differ from that in OA.

Ann RheumDis.2018 Aug;77(8):1137-1142. doi:10.1136/annrheumdis-2018-213089. Epub 2018 Apr 19.