Glucocorticoids a cardiovascular risk – curative practice

Appropriate treatment recommendations for rheumatoid arthritis

After various studies linked glucocorticoids (cortisone) to an increased risk of cardiovascular events, the European Alliance of Rheumatology Associations (EULAR) treatment recommendations for rheumatoid arthritis (also chronic arthritis) have been revised .

The German Society for Rheumatology eV (DGRh) has expressly approved the adjustment of the treatment recommendations at European level and points out in a current press release that the DGRh treatment guidelines were already adjusted in 2018 on the basis of the findings on glucocorticoids.

Chronic inflammatory joint disease

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that affects up to 0.8% of adults in Germany, according to the Robert Koch Institute (RKI).

Depending on the severity of the disease, chronic inflammation of the synovial membranes rapidly or gradually leads to the destruction of adjacent cartilage and bone. Most of the time, joints away from the middle of the body are affected symmetrically.

In addition to joint pain, typical symptoms include symptoms such as exhaustion, weakness and the accompanying tendonitis, reports the RKI. As a rule, RA progresses in phases, and as the disease progresses, joint deformities appear, which can go as far as complete destruction of the joints.

Symptoms are often already severe at the time of diagnosis

When the diagnosis of “rheumatoid arthritis” is made, sufferers often already suffer from severe symptoms, joints all over the body are painfully inflamed and their quality of life is significantly impaired, reports the DGRh.

Until basic treatment with so-called conventional, synthetically produced DMARDs (disease-modifying antirheumatic drugs) such as methotrexate shows an effect, glucocorticoids (cortisone preparations) are often used initially.

These quickly suppress inflammation, immediately alleviate the symptoms of the disease and thus bridge the time until the basic drug takes effect, explains the DGRh.

Serious cardiovascular side effects

“However, glucocorticoids have a wide range of possible adverse effects, especially if taken over a long period of time or in large amounts,” adds medical professor Dr. André Krause.

“With regard to cardiovascular events – that is, those affecting the heart and vascular system – these include heart attacks, strokes, uncontrolled high blood pressure and thrombosis,” continues the report. ‘expert.

Quickly stop cortisone preparations

Therefore, great care should be taken to dose glucocorticoids only for as short a time as possible and as low as necessary. EULAR recommendations are now more concrete in this regard by adding that glucocorticoids should not only be reduced as soon as possible, but reduced and then stopped.

Since 2018, the DGRh recommendation recommends limiting corticosteroid therapy to three to six months. “This implies that even very small doses of less than five milligrams a day should not be given as long-term treatment, but should be further reduced and discontinued,” says Professor Krause.

Because for the cardiovascular risk not only the daily intake but also the total quantity of glucocorticoids taken over time is decisive, reports the DGRh.

Adjusted recommendation on JAK inhibitors

EULAR has also updated its recommendations on so-called Janus kinase inhibitors (JAK inhibitors) in RA because some recent studies have raised questions about safety in people at increased cardiovascular risk.

The EULAR recommendation does not generally advise against JAK inhibitors, as they can continue to be given as second-line treatment if conventional DMARDs do not respond sufficiently. However, risk factors such as cardiovascular and infectious risk factors should be given special attention.

Consider individual risk factors

“These individual risk factors play an important role in every treatment decision,” emphasizes medical Dr. Jan Leipe of Mannheim University Hospital, who coordinated the development of the DGRh guideline on cardiovascular comorbidities in inflammatory rheumatic diseases. .

It is therefore important to identify these individual risk factors, to inform those affected of their importance for the treatment of RA and to make a treatment decision together.

Last but not least, “patients respond differently to drug therapies, and side effects also differ,” adds Professor Krause.

In addition, certain personal preferences should be taken into account when choosing treatment, as this may affect compliance with treatment. It is therefore also to be welcomed that the new EULAR recommendations essentially maintain freedom of treatment. (fp)

Author and source information

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This text corresponds to the specifications of the specialized medical literature, medical guidelines and current studies and has been verified by health professionals.

Sources:

Robert Koch Institute (RKI): Inflammatory rheumatic diseases (accessed July 25, 2022), rki.deGerman Society for Rheumatology eV (DGRh): Rheumatism and cardiovascular risk (published July 21, 2022), dgrh.de

Important note:
This article contains general advice only and should not be used for self-diagnosis or treatment. It cannot substitute a visit to the doctor.

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