Effect of glucocorticoids on the arteries in rheumatoid arthritis

Abstract

Objective. Glucocorticoids are suspected to cause atherosclerosis. Because of the possibility that their antiinflammatory effect may be antiatherogenic, this study investigated the effect of glucocorticoids on the arteries of patients with rheumatoid arthritis (RA).Methods. We assessed the arteries of 647 patients with RA. Central atherosclerosis was measured using high-resolution carotid ultrasound for the presence of plaque and for the extent of carotid artery intima-media thickness (CaIMT). Peripheral atherosclerosis was assessed using the systolic pressures of the dorsal pedal, posterior tibial, and brachial arteries to obtain the ankle-brachial index (ABI). Cumulative glucocorticoid dose was determined using pharmacy records, supplemented by self-report. Cardiovascular (CV) risk factors and RA clinical manifestations were ascertained using clinical and laboratory methods.Results. Among the RA patients studied, 427 (66%) had received glucocorticoids. Of those who had never received glucocorticoids, 100 (47%) of 215 had carotid plaque and 17 (8%) of 219 had >1 incompressible lower-limb artery (ABI >1.3). Among patients in the highest tertile of lifetime glucocorticoid exposure (>16.24 gm prednisone), the frequency of carotid plaque increased to 85 (62%) of 138 (P ‫؍‬ 0.006) and that of lower-limb arterial incompressibility increased to 24 (17%) of 140 (P ‫؍‬ 0.008), with differences remaining significant after adjustment for age at onset, disease duration, sex, CV risk factors, and RA clinical manifestations (tender, swollen, and deformed joint counts, subcutaneous nodules, rheumatoid factor seropositivity, and erythrocyte sedimentation rate). The CaIMT also displayed an increase with higher glucocorticoid exposure, but the differences did not reach significance. Lower-limb artery obstruction (ABI <0.9) was not associated with glucocorticoid exposure.Conclusion. In this RA sample, glucocorticoid exposure was associated with carotid plaque and arterial incompressibility, independent of CV risk factors and RA clinical manifestations. This supports a role for glucocorticoids in the CV complications that occur in RA.

Reduced carotid atherosclerosis in asthmatic patients treated with inhaled corticosteroids

“…Only a few studies have been carried out to analyse the effects of corticosteroids on the arteries as well as on cardiovascular events. Oral corticosteroid treatment has been reported to be associated with the progression of atherosclerosis, independent of traditional risk factors in patients with rheumatoid arthritis and systemic lupus erythematosus [25,26]. The large cohort study of VARAS-LORENZO et al [9] reported that the use of oral corticosteroids was associated with a greater risk of acute myocardial infarction in .40,000 subjects from the general UK population.…”

Effects of Keishibukuryogan on Vascular Function in Adjuvant-Induced Arthritis Rats

“…12) However, it has also been reported that serum levels of cholesterol of RA patients, a risk factor of atherosclerosis, are lower than those of healthy people, 13) and the body mass index of RA patients is also lower than that of healthy people. 14) This means that the cause of advancing atherosclerosis in RA patients remained unclear.…”

Lack of cardiovascular risk assessment in inflammatory arthritis and systemic lupus erythematosus patients at a tertiary care center

“…Certain medications used to treat IA and SLE may also contribute to the increased risk of CVD, including nonsteroidal anti-inflammatory drugs (NSAIDs) [20], COX-2 inhibitors [5,20], steroids [21,22], and anti-folate medications such as methotrexate [23,24].…”