Athanase D. Protogerou, MD; Evangelia Zampeli, MD; Petros P. Sfikakis, MD
Potential Conflicts of Interest: None disclosed.
Protogerou AD, Zampeli E, Sfikakis PP. Low-Dose Prednisone Inclusion in a Methotrexate-Based, Tight Control Strategy for Early Rheumatoid Arthritis. Ann Intern Med. 2012;157:299-300. doi: 10.7326/0003-4819-157-4-201208210-00019
Download citation file:
Published: Ann Intern Med. 2012;157(4):299-300.
TO THE EDITOR:
Rheumatoid arthritis is associated with increased mortality, and most premature deaths are attributable to cardiovascular disease (1). Both chronic active inflammation, as a result of inadequate disease control, and the increased burden of traditional cardiovascular risk factors in these patients contribute to the acceleration of atherosclerosis (1–3). Bakker and colleagues (4) clearly showed the beneficial effect of a low to moderate dose of prednisone (10 mg/d) on tight control for RA when incorporated into treatment during the first 2 years after disease onset. Patient age at baseline was about 53 years, and none had serious cardiac disease or inadequately controlled hypertension and diabetes mellitus. Apart from 1 death due to coronary syndrome among 85 patients who completed the study receiving additional prednisone, no serious cardiovascular adverse effects were noted. One could assume that the beneficial effect of prednisone is translated in deceleration of atherosclerosis because inflammatory activity is better controlled. However, evidence from retrospective studies suggests otherwise—the high cumulative dose of prednisone is associated with later development of the acute coronary syndrome in patients with RA (5). An average cumulative daily dose of prednisone less than 2.5 mg at baseline (2), or 2.5 mg to 10 mg daily (3), were independently associated with progression of subclinical carotid atherosclerosis over 3 years (intima–media thickening or new plaque formation). Of note, these carotid markers are independent predictors of cardiovascular mortality in patients with RA (5), implying that even low-dose corticosteroids contribute to the increased cardiovascular risk in these patients.
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only