Incident Comorbidity Among Patients with Rheumatoid Arthritis Treated or Not with Low-dose Glucocorticoids: A Retrospective Study

Mazzantini, M; Talarico, Rosaria; Doveri, M.; Consensi, Arianna; Cazzato, Massimiliano; Bazzichi, Laura; Bombardieri, Stefano

doi:10.3899/jrheum.100461

Cited by 39 publications

(26 citation statements)

References 14 publications

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“…Indeed, longterm GC therapy was associated with the development of arterial hypertension in our study 4 , and undoubtedly this can predispose to cardiovascular diseases. Similar results were found in rheumatoid arthritis 5 . There are probably only 2 ways to reduce the risk of GC-related cardiovascular adverse events: first, to shorten the GC duration/cumulative dose whenever possible, not relying on the safety of low-dose GC; and second, to strictly monitor arterial pressure and protect the cardiovascular system with the available prevention strategies.…”

Section: To the Editorsupporting

confidence: 89%

Dr. Mazzantini replies

Mazzantini¹

2012

J Rheumatol

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Section: To the Editorsupporting

confidence: 89%

Dr. Mazzantini replies

Mazzantini¹

2012

J Rheumatol

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“…In contrast to the RCTs which showed no association between GC use and all cataracts (RD 0.01, 95%CI -0.01–0.03), an association was observed in the observational cohort studies [22–26], with a estimated risk difference of 0.07, 95%CI 0.04–0.10. The RCT and observational literature regarding glaucoma was particularly limited as was that addressing the effect of dose and duration of GC therapy.…”

Section: Discussioncontrasting

confidence: 66%

“…They found that both cataract and glaucoma fit the threshold pattern with a threshold dose of 5mg per day for cataract and 7.5mg per day for glaucoma in patients on GCs for more than 6 months. Mazzantini et al [26] did not find any difference in cataract prevalence between those treated with GCs for <2 years, 2–5 years or >5years.…”

Section: Resultsmentioning

confidence: 98%

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The Association between Systemic Glucocorticoid Use and the Risk of Cataract and Glaucoma in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

et al. 2016

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ObjectiveGlucocorticoids (GCs) are often used to treat Rheumatoid Arthritis (RA) despite their many side effects and the availability of other effective therapies. Cataract and glaucoma are known side effects of GCs but the risk of them developing in the setting of GC use for RA is unknown. The aim was to perform a systematic review and meta-analysis to determine the association between GCs and the risk of developing cataract and/or glaucoma in RA.MethodsA systematic search was carried out using MEDLINE, EMBASE, and Web of Science. All RCTs comparing GC use to non-use in RA populations were sought. Observational studies reporting cataract and/or glaucoma amongst GC users and non-users were also included. Data extracted included incidence/prevalence of cataract and/or glaucoma in each arm, dose and duration of therapy. Two independent reviewers performed quality assessment.Results28 RCTs met eligibility criteria, however only 3 reported cataracts and glaucoma, suggesting significant under-reporting. An association between GC use and the development of cataracts in RA patients was seen in observational studies but not RCTs. There was no statistically significant association between GC use and the development of glaucoma, although data were sparse. There were insufficient data to determine the impact of dose and duration of therapy.ConclusionThe current literature suggests a possible association between GC use and the development of cataract. However, this risk cannot be accurately quantified in RA from the available evidence. RCTs have not adequately captured these outcomes and well-designed observational research is required.

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“…The task force debated whether there was a safe lower level of glucocorticoid dosing. While this question has been studied in other diseases where no such safe lower level could be identified,96 97 there are no studies specifically addressing this issue in SLE. Nonetheless, based on the available evidence and general pharmacological considerations, the task force supported the main recommendation to aim for the lowest glucocorticoid dosage during maintenance treatment, and the comment to withdraw glucocorticoids completely ‘if possible’.…”

Section: Resultsmentioning

confidence: 99%

Treat-to-target in systemic lupus erythematosus: recommendations from an international task force

et al. 2014

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The principle of treating-to-target has been successfully applied to many diseases outside rheumatology and more recently to rheumatoid arthritis. Identifying appropriate therapeutic targets and pursuing these systematically has led to improved care for patients with these diseases and useful guidance for healthcare providers and administrators. Thus, an initiative to evaluate possible therapeutic targets and develop treat-to-target guidance was believed to be highly appropriate in the management of systemic lupus erythematosus (SLE) patients as well. Specialists in rheumatology, nephrology, dermatology, internal medicine and clinical immunology, and a patient representative, contributed to this initiative. The majority convened on three occasions in 2012-2013. Twelve topics of critical importance were identified and a systematic literature review was performed. The results were condensed and reformulated as recommendations, discussed, modified and voted upon. The finalised bullet points were analysed for degree of agreement among the task force. The Oxford Centre level of evidence (LoE, corresponding to the research questions) and grade of recommendation (GoR) were determined for each recommendation. The 12 systematic literature searches and their summaries led to 11 recommendations. Prominent features of these recommendations are targeting remission, preventing damage and improving quality of life. LoE and GoR of the recommendations were variable but agreement was >0.9 in each case. An extensive research agenda was identified, and four overarching principles were also agreed upon. Treat-to-target-in-SLE (T2T/SLE) recommendations were developed by a large task force of multispecialty experts and a patient representative. It is anticipated that 'treating-to-target' can and will be applicable to the care of patients with SLE.

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Incident Comorbidity Among Patients with Rheumatoid Arthritis Treated or Not with Low-dose Glucocorticoids: A Retrospective Study

Cited by 39 publications

References 14 publications

Dr. Mazzantini replies

Dr. Mazzantini replies

The Association between Systemic Glucocorticoid Use and the Risk of Cataract and Glaucoma in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Treat-to-target in systemic lupus erythematosus: recommendations from an international task force

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