found a (cumulative) dose and duration dependent increase in CVD related morbidity and mortality in RA patients.48;168However, this does not mean that confounding by indication has been completely addressed and this is a major limitation of all safety studies on corticosteroids. There is no conclusive evidence about the long-term effects of corticosteroids, particularly in low daily dosage, on safety outcomes including CVD events in RA. In patients with active disease, the benefit of reducing high grade inflammation may counteract the adverse CVD effects of corticosteroid use, not only by reduction of inflammation, but also by improving mobility. In other words steroids may help to abrogate the harmful effect of inflammation on the CVD system, but they will still carry their own adverse effects on CVD risk. Altogether, from a CVD prevention point of view, the lowest effective dose of corticosteroids should be prescribed for the shortest possible duration in the treatment of active IJD. This recommendation is in line with the EULAR recommendations on management of glucocorticoid therapy.45
found a (cumulative) dose and duration dependent increase in CVD related morbidity and mortality in RA patients.48;168However, this does not mean that confounding by indication has been completely addressed and this is a major limitation of all safety studies on corticosteroids. There is no conclusive evidence about the long-term effects of corticosteroids, particularly in low daily dosage, on safety outcomes including CVD events in RA. In patients with active disease, the benefit of reducing high grade inflammation may counteract the adverse CVD effects of corticosteroid use, not only by reduction of inflammation, but also by improving mobility. In other words steroids may help to abrogate the harmful effect of inflammation on the CVD system, but they will still carry their own adverse effects on CVD risk. Altogether, from a CVD prevention point of view, the lowest effective dose of corticosteroids should be prescribed for the shortest possible duration in the treatment of active IJD. This recommendation is in line with the EULAR recommendations on management of glucocorticoid therapy.45