2023-10-25 08:39:30
by Carlo Selmi
Chronic inflammation not controlled by treatments is a factor that directly affects arterial damage. But drugs can cancel the effect
I have suffered from rheumatoid arthritis for many years and am forced to take cortisone to stay well. However, I have read that very prolonged therapy could cause cardiovascular problems. What could I do? Are there any alternatives to cortisone that are equally effective in treating my disease?
Carlo Selmi, head of Rheumatology and Clinical Immunology, Humanitas Institute, Milan responds (GO TO THE FORUM)
Chronic inflammation, such as that seen in rheumatoid arthritis, which is not controlled by treatments, is a factor that directly affects the severity of atherosclerosis, i.e. the damage to the arteries underlying acute events that can cause heart attack or stroke, which in fact are more frequent in those suffering from the disease. However, it has been well demonstrated that controlling the activity of the disease with drugs such as methotrexate or some biologics can cancel out the effect of rheumatoid arthritis on the risk of having one of these events.
International recommendations agree in including these therapies as first choice immediately after diagnosis, together with a short course of cortisone drugs (the most used are prednisone or methylprednisolone), which allow a rapid improvement of symptoms. Although the same recommendations specify that the use of the latter must be limited in time, in many cases unfortunately the therapy is continued for many years at low doses, imagining that these are harmless.
A study published by scientists from Hong Kong observed over 12 thousand patients with rheumatoid arthritis for an average of almost nine years and recorded cases of acute cardiovascular events such as heart attack or stroke, demonstrating that the threshold dosage of 5 mg of prednisone per day day (equivalent to 4 mg methylprednisolone). Specifically, those taking a daily dosage lower than this did not have an increased risk of acute cardiovascular events, while a dosage of 5 mg or higher was associated with a higher risk, regardless of other factors. Furthermore, the probability increased by 7 percent for each year of prednisone use at a dose equal to or greater than 5 mg per day.
In those suffering from rheumatoid arthritis, it is therefore very important to use drugs that allow for as rapid withdrawal of cortisone as possible, but also to encourage people to stop smoking, combat obesity and overweight (even with an active lifestyle) and control cholesterol levels. and triglycerides.
October 25, 2023 (modified October 25, 2023 | 08:39)
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