RESEARCH - Effect of steroids on the arteries in RA

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Arthritis Rheum. 2004 Dec;50(12):3813-22.

Effect of glucocorticoids on the arteries in rheumatoid arthritis.

del Rincon I, O'Leary DH, Haas RW, Escalante A.

The University of Texas Health Science Center at San , San ,

TX 78229, USA. delrincon@...

OBJECTIVE: Glucocorticoids are suspected to cause atherosclerosis. Because

of the possibility that their antiinflammatory effect may be

antiatherogenic, this study investigated the effect of glucocorticoids on

the arteries of patients with rheumatoid arthritis (RA). METHODS: We

assessed the arteries of 647 patients with RA. Central atherosclerosis was

measured using high-resolution carotid ultrasound for the presence of plaque

and for the extent of carotid artery intima-media thickness (CaIMT).

Peripheral atherosclerosis was assessed using the systolic pressures of the

dorsal pedal, posterior tibial, and brachial arteries to obtain the

ankle-brachial index (ABI). Cumulative glucocorticoid dose was determined

using pharmacy records, supplemented by self-report. Cardiovascular (CV)

risk factors and RA clinical manifestations were ascertained using clinical

and laboratory methods. RESULTS: Among the RA patients studied, 427 (66%)

had received glucocorticoids. Of those who had never received

glucocorticoids, 100 (47%) of 215 had carotid plaque and 17 (8%) of 219 had

> or =1 incompressible lower-limb artery (ABI >1.3). Among patients in the

highest tertile of lifetime glucocorticoid exposure (>16.24 gm prednisone),

the frequency of carotid plaque increased to 85 (62%) of 138 (P = 0.006) and

that of lower-limb arterial incompressibility increased to 24 (17%) of 140

(P = 0.008), with differences remaining significant after adjustment for age

at onset, disease duration, sex, CV risk factors, and RA clinical

manifestations (tender, swollen, and deformed joint counts, subcutaneous

nodules, rheumatoid factor seropositivity, and erythrocyte sedimentation

rate). The CaIMT also displayed an increase with higher glucocorticoid

exposure, but the differences did not reach significance. Lower-limb artery

obstruction (ABI < or =0.9) was not associated with glucocorticoid exposure.

CONCLUSION: In this RA sample, glucocorticoid exposure was associated with

carotid plaque and arterial incompressibility, independent of CV risk

factors and RA clinical manifestations. This supports a role for

glucocorticoids in the CV complications that occur in RA.

PMID: 15593231

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15593231 & itool=iconabstr

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