Can cortisone for rheumatoid arthritis damage the heart? – WWN

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?

He replies Carlo SelmiHead of Rheumatology and Clinical Immunology, Humanitas Institute, Milan (GO TO THE FORUM)

Chronic inflammationsuch as that seen in rheumatoid arthritis, Uncontrolled by treatments is a factor that directly affects the severity of atherosclerosis, that is, the damage to the arteries at the basis of acute events that can cause heart attack or stroke, which in fact are more frequent in those who suffer from the disease. but it has been well demonstrated how controlling the activity of the disease with drugs such as methotrexate or some biologics can reverse the effect of rheumatoid arthritis about 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 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 the cases of acute cardiovascular events such as heart attack or stroke, demonstrating that the threshold dosage of 5 mg of prednisone per day (equivalent to 4 mg of 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 of great importance to use drugs that allow as rapid a suspension of the cortisone as possiblebut also encourage people to stop smoking, fight obesity and overweight (even with an active lifestyle) and control cholesterol and triglyceride levels.