EDITORIAL - Use of low-dose glucocorticoids and the risk of CV morbidity and mortality in RA

[Guest guest]

The Journal of Rheumatology

October 2005

" Use of Low-Dose Glucocorticoids and the Risk of Cardiovascular Morbidity

and Mortality in Rheumatoid Arthritis: What Is the True Direction of

Effect? " :

People with rheumatoid arthritis (RA) experience an increased burden of

cardiovascular disease (CVD) and reduced survival compared to the general

population1. Myocardial infarction (MI) and heart failure appear to be more

prevalent in RA compared to subjects without RA2. In one study, the risk of

congestive heart failure was 2-fold higher among RA subjects compared to

non-RA controls3. Much of the best evidence suggests that systemic

inflammation plays an important role in the pathogenesis of CVD in RA1.

Still, a nagging question persists in the minds of many rheumatologists

today: What is the role of glucocorticoids (GC)? A common view is that GC

harm the cardiovascular system. We wish to examine an alternative

hypothesis: that GC might actually reduce the risk of CVD in patients with

RA. Our aim is not to provide a comprehensive review of the cardiovascular

effects of GC but rather to bring balance to the debate of how use of GC

might affect the development of CVD in patients with RA.

A discussion of GC is highly relevant given current rheumatology practice.

GC have been used to treat people with RA for the last half-century, and

recently, there has been renewed interest in these medications4. Use of GC

is highly prevalent among people with RA; for example, these are taken by

30-50% of patients enrolled in recent therapeutic trials5. Rheumatologists

commonly use GC as " bridge therapy " awaiting efficacy of slow-acting disease

modifying antirheumatic drugs (DMARD), and also for treating disease flares.

Frequently, delays occur in initiating biologic agents due to time required

for insurance company authorization, tuberculin skin testing, and/or patient

education visits. For these reasons, GC will likely continue to be an

important component of the armamentarium for patients with RA, at least for

the foreseeable future.

************************

For the rest of this editorial, please see:

http://www.jrheum.com/subscribers/05/10/1856.html

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org