背景:Legg-Calvé-Perthes病(LCPD)和滑脱股骨骨phy(SCFE)可导致髋关节疼痛变形,活动范围受损和继发性骨关节炎的早期发展。尚未研究LCPD或SCFE是否与以后生活中疼痛或抗抑郁药处方的使用增加有关。
目的:通过这项研究,我们的目的是调查有LCPD或SCFE病史的患者在成年期服用处方镇痛药或抗抑郁药的风险是否比对照组增加.
方法:纳入的患者由瑞典患者登记册确定,并进行年龄匹配,性别,和居住与10个对照个体没有接触任何提到的小儿髋关节疾病,瑞典国家人口登记册。
方法:这是一个全国性的,基于注册的队列研究包括1,292例2-15岁诊断为LCPD的患者和1,613例5-16岁和>17岁诊断为SCFE的患者,从2005年到2011年.
方法:一线镇痛药物的处方数据(对乙酰氨基酚,非甾体抗炎药,和阿片类药物),或一线抗抑郁药(选择性5-羟色胺再摄取抑制剂,5-羟色胺-去甲肾上腺素再摄取抑制剂,和三环抗抑郁药)来自瑞典处方药物登记册。拟合条件逻辑回归模型,以估计与未暴露个体相比,暴露者处方的相对风险。对性别和出生年份进行了调整。
结果:在诊断为LCPD的组中,止痛处方的校正比值比总体为1.3(95%CI,1.2~1.5).对于有SCFE诊断的患者,止痛处方的校正比值比总体为1.4(95%CI,1.3~1.6).在诊断为LCPD的患者中,抗抑郁药总体处方的校正比值比为1.0(95%CI,0.8~1.2).对于有SCFE诊断的患者,校正比值比为1.2(95%CI,1.1-1.4).
结论:与所有注册研究一样,有已知的相关偏见,如选择,检测,和观测偏差以及输入数据的不确定质量。Further,瑞典处方药物登记册仅包括由医生处方并在药房分配的药物。这也是一个可能导致低估对乙酰氨基酚和非甾体抗炎药的使用的因素,因为这些药物可以通过非处方药获得。\"
结论:在童年时期,患有LCPD或SCFE的患者似乎遭受长期疼痛,并且在成年期需要镇痛药物的风险增加,包括阿片类药物。重要的是要评估原因,type,和疼痛的严重程度,以优化疼痛管理,以抵消这些患者可能的过度使用。似乎,LCPD患者在成年期接受抗抑郁药物治疗的风险没有增加,而我们确实发现,与普通人群相比,既往有SCFE的患者接受抗抑郁药物治疗的风险增加.
BACKGROUND: Legg-Calvé-Perthes disease (LCPD) and slipped capital femoral epiphysis (SCFE) can result in painful deformation of the hip joint with impaired range of motion and early development of secondary osteoarthritis. It has not been investigated whether having LCPD or SCFE is associated with increased use of pain or antidepressant drug prescriptions later in life.
OBJECTIVE: With this study, we aimed to investigate if patients with a history of LCPD or SCFE have an increased risk of prescription analgesic or antidepressant drugs in adulthood compared with matched controls.
METHODS: The included patients were identified by the Swedish Patient Register and matched for age, gender, and residency with 10 control individuals not exposed to any of the mentioned pediatric hip diseases, by the Swedish National Population Register.
METHODS: This was a nationwide, registry-based cohort study which included 1,292 patients diagnosed with LCPD at age 2-15 years and 1,613 patients diagnosed with SCFE at age 5-16 years and > 17 years from 2005 through 2011.
METHODS: Prescription data of first-line analgesic drugs (acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids), or first-line antidepressant drugs (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants) were derived from the Swedish Prescribed Drugs Register. Conditional logistic regression models were fitted to estimate the relative risk for the prescription in exposed compared with unexposed individuals. Adjustment was performed for gender and birth year.
RESULTS: In the group with an LCPD diagnosis, the adjusted odds ratio for analgesic prescriptions overall was 1.3 (95% CI, 1.2-1.5). For patients with an SCFE diagnosis, the adjusted odds ratio for analgesic prescriptions overall was 1.4 (95% CI, 1.3-1.6). Among patients with an LCPD diagnosis, the adjusted odds ratio for antidepressant prescriptions overall was 1.0 (95% CI, 0.8-1.2). For patients with an SCFE diagnosis, the adjusted odds ratio was 1.2 (95% CI, 1.1-1.4).
CONCLUSIONS: As with all register studies, there are known associated biases such as selection, detection, and observational bias as well as the uncertain quality of input data. Further, the Swedish Prescribed Drugs Register only includes drugs that were prescribed by a physician and dispensed at a pharmacy. This is also a factor that may lead to underestimating the use of acetaminophen and nonsteroidal anti-inflammatory drugs, as these drugs can be acquired \"over the counter.\"
CONCLUSIONS: During childhood, patients with LCPD or SCFE seem to suffer long-term pain and have an increased risk of requiring analgesic medication in adulthood, including opioids. It is important to assess the causes, type, and severity of pain to optimize pain management to counteract possible overuse in these patients. Seemingly, patients with LCPD do not have an increased risk for antidepressant drug therapy in adulthood whereas we did see an increased risk for that in patients with previous SCFE compared with the general population.