Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data

Silva, José António Pereira da

doi:10.1136/ard.2005.038638

Cited by 449 publications

(295 citation statements)

References 139 publications

(102 reference statements)

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“…Despite the commonly held belief that low-dose glucocorticoids are detrimental to the CV system, relatively little evidence exists in support of this hypothesis (7). Investigators have reported conflicting data on the relationship between use of glucocorticoids and CV events in epidemiologic studies of RA (22).…”

Section: Discussionmentioning

confidence: 99%

“…The undesirable effects of glucocorticoids on blood pressure, insulin resistance, lipid profile, body weight and fat distribution, and coagulation proteins might significantly increase the risk of CVD in RA patients (1,2,4,6). Although the literature supports the development of these potentially harmful effects with high-dose glucocorticoid therapy, it has been recognized that there is no firm evidence linking low-dose therapy and CVD in the RA population (7,8). On the contrary, recent studies have suggested that low-dose glucocorticoid treatment is associated with potentially beneficial effects on the cardiovascular (CV) system, such as improvements in the lipid profile (9)(10)(11) as well as insulin sensitivity (12,13).…”

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confidence: 99%

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Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population‐based cohort study

Davis¹,

Kremers²,

Crowson³

et al. 2007

Arthritis & Rheumatism

220

122

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Objective. To determine the relationship between glucocorticoid exposure and cardiovascular (CV) events in patients with rheumatoid arthritis (RA).Methods. A total of 603 adult residents of Rochester, Minnesota with incident RA between 1955 and 1995 were followed up through their medical records for a median of 13 years (total of 9,066 person-years). Glucocorticoid exposure was defined 3 ways: tertiles of cumulative exposure; recent use (<3 months) versus past use (>3 months); and average daily dosage (<7.5 mg/day or >7.5 mg/day). CV events, including myocardial infarction, heart failure, and death from CV causes, were defined according to validated criteria. Cox regression models were adjusted for demographic features, CV risk factors, and RA characteristics.Results. Rheumatoid factor (RF)-negative patients with exposure to glucocorticoids were not at increased risk of CV events, irrespective of the glucocorticoid dosage or timing of use, as compared with the reference group of RF-negative patients who had never been exposed to glucocorticoids. In contrast, RFpositive patients were at increased risk of CV events, particularly with higher cumulative exposure, higher average daily dosage, and recent use of glucocorticoids. RF-positive patients with high cumulative exposure to glucocorticoids had a 3-fold increased risk of CV events (hazard ratio 3.06 [95% confidence interval 1.81-5.18]), whereas RF-negative patients with high cumulative exposure were not at increased risk (hazard ratio 0.85 [95% confidence interval 0.39-1.87]).Conclusion. RF-positive but not RF-negative patients were at increased risk of CV events following exposure to glucocorticoids. These findings suggest that glucocorticoids interact with RF status to modulate the occurrence of CV events in patients with RA. The mechanisms underlying this interaction are unknown and should be the subject of further research.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population‐based cohort study

Davis¹,

Kremers²,

Crowson³

et al. 2007

Arthritis & Rheumatism

220

122

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“…Although some short-term RCTs have been conducted for example to assess efficacy of low-dose glucocorticoids as disease modifiers in early rheumatoid arthritis (98), it seems certain that RCTs will never be conducted which have sufficient statistical power and duration of exposure to detect effects of glucocorticoids on cardiovascular events. It would be considered unethical to withhold glucocorticoid therapy from patients with inflammatory disease, and unethical to expose patients who do not need anti-inflammatory therapy to the known adverse effects of glucocorticoids (fractures, hyperglycaemia, etc.)…”

Section: Exogenous Anti-inflammatory Glucocorticoidsmentioning

confidence: 99%

Glucocorticoids and Cardiovascular Disease

Walker¹

2007

European Journal of Endocrinology

467

386

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Chronic excessive activation of glucocorticoid receptors induces obesity, insulin resistance, glucose intolerance, dyslipidaemia and hypertension. Subtle abnormalities of the hypothalamic-pituitaryadrenal axis and/or of tissue sensitivity to glucocorticoids are also associated with these cardiovascular risk factors in patients with the metabolic syndrome. Furthermore, glucocorticoids have direct effects on the heart and blood vessels, mediated by both glucocorticoid and mineralocorticoid receptors and modified by local metabolism of glucocorticoids by the 11b-hydroxysteroid dehydrogenase enzymes. These effects influence vascular function, atherogenesis and vascular remodelling following intravascular injury or ischaemia. This article reviews the systemic and cardiovascular effects of glucocorticoids, and the evidence that glucocorticoids not only promote the incidence and progression of atherogenesis but also modify the recovery from occlusive vascular events and intravascular injury. The conclusion is that manipulation of glucocorticoid action within metabolic and cardiovascular tissues may provide novel therapeutic avenues to combat cardiovascular disease.European Journal of Endocrinology 157 545-559

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“…As immunosuppressive drug the option was a low-dose prednisolone with its glucocorticoid effect [9,10]. As it is visible in the Figure 3 …”

Section: Treatment Of Chronic Ear Infection With Polyposis -A Case Rementioning

confidence: 95%

Treatment of Chronic Ear Infection with Polyposis - A Case Report

Milicic¹

2017

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Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data

Cited by 449 publications

References 139 publications

Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population‐based cohort study

Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population‐based cohort study

Glucocorticoids and Cardiovascular Disease

Treatment of Chronic Ear Infection with Polyposis - A Case Report

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