Steroid increases risk of heart issues for arthritis patients: Hong Kong scientists

Rheumatoid arthritis patients taking more than five milligrams of a common steroid drug a day are twice as likely to suffer from major heart problems than those not prescribed the medication, according to a study from a university in Hong Kong.

A Chinese University (CUHK) paper also found that if the patients continuously took more than 5mg each day of anti-inflammation treatment glucocorticoid, the risk of major adverse cardiovascular events increased by 7 per cent every month.

“We suggest doctors maintain a careful balance of risks and benefits when prescribing glucocorticoid to rheumatoid arthritis patients and to discontinue or taper to less than 4mg daily as soon as possible,” said Dr So Ho, an assistant professor at CUHK’s department of medicine and therapeutics, on Wednesday.

“It is known that long-term use of steroids can lead to common cardiovascular conditions, such as hypertension, high cholesterol levels and diabetes. But at the same time, it can control inflammation. That is why we did the research.”

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Rheumatoid arthritis occurs when the immune system attacks the membrane lining of a person’s joints and causes inflammation, resulting in pain and swelling, as well as stiffness and loss of function in the affected areas.

Patients with the condition are more likely to suffer from cardiovascular diseases.

The university study cited estimates that put the number of people in Hong Kong suffering from rheumatoid arthritis at about 22,000.

Researchers also reviewed data from 12,233 rheumatoid arthritis adult patients who had received treatments at public hospitals from 2006 to 2015, as well as looking over the participants’ follow-up data from 2018 onwards.

The study found that none of the patients were diagnosed with major adverse cardiovascular events before starting any treatments. The term covers conditions such as myocardial infarction, unstable angina, ischemic or haemorrhagic cerebrovascular incident or transient ischemic attack.

Among the patients, about 37 per cent were prescribed glucocorticoids. The rest received other treatment options.

But researchers discovered that the risk of heart problems increased by 7 per cent each month if patients took more than 5mg of glucocorticoid. Those taking the medication were also twice as likely to experience such health conditions than those not prescribed the drug.

The paper also found that patients taking less than 5mg per day did not face an increased risk of major adverse cardiovascular events.

The study was published in international journal Annals of the Rheumatic Diseases in July.

Assistant Professor So on Wednesday noted that about 60 per cent of rheumatoid arthritis patients globally were using the medication long-term, with doctors typically prescribing 10mg to 15mg each day.

While the scholar acknowledged there was no direct evidence showing prescribing less than 5mg of glucocorticoid a day could manage rheumatoid arthritis, he said overseas studies had shown reducing the dosage had limited effect on treating the condition.

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Professor Tam Lai-shan, head of CUHK’s rheumatology division, advised doctors to be cautious when prescribing the medication.

“The effects of other medicines for adjusting the immune system may only show after three to four months after usage. If the patient has high disease activity with a lot of pain and stiffness, and cannot walk, then they need something to rapidly relieve their symptoms, so the role of steroids would be as a bridging therapy,” she said.

“Typically, we give patients about 10mg or less of the steroid every day and then we tell them to taper it as quickly as possible. So, this is how we like to use steroids among our patients.”

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But she warned that patients should not simply stop taking glucocorticoid without discussing the decision with their doctors.

“Suddenly stopping these steroids could lead to adrenal insufficiency and other problems, such as dizziness. Thus, patients should not stop taking steroids all of a sudden on their own,” she said. “Patients should talk to their doctors to see if it is okay to cut back or stop and follow their instructions.”

Patients could consider taking alternative medicines such as biological or targeted synthetic disease-modifying antirheumatic drugs, which had become more affordable in recent years, Tam said.