#VisualAbstract: Low-dose glucocorticoids for rheumatoid arthritis do not increase blood pressure

1.  In this pooled analysis of randomized controlled trials, low-dose glucocorticoids taken over a two-year period did not increase patient blood pressure.

2. Low-dose glucocorticoid use was associated with an increase in weight of one kilogram on average. 

Evidence Rating Level: 1 (Excellent)

Study Rundown: Glucocorticoids are commonly used in the management of rheumatoid arthritis (RA), though are often associated with adverse events such as weight gain and hypertension. However, there is a gap in knowledge as to understanding whether glucocorticoids are truly the cause of these adverse events. For example, because patients with more severe disease are more likely to be treated with glucocorticoids, and dose and duration are also strongly associated with disease severity, it is difficult to disentangle the effects of glucocorticoids and disease severity in an observational study. Overall, this study found that by combining data from randomized controlled trials, they were able to find that low-dose glucocorticoid treatment of two years leads to a modest weight gain of one kilogram but has no effect on blood pressure. This study was limited by not assessing body composition and may not be generalizable to non-European regions. Nevertheless, these study’s findings are significant, as they demonstrate that low-dose glucocorticoid treatment over 2 years does not affect blood pressure, though does lead to a small weight gain in the treatment of RA.

Click to read the study in AIM

Relevant Reading: Summary for Patients: The Effect of Low-Dose Glucocorticoids Over Two Years on Weight and Blood Pressure in Rheumatoid Arthritis

In-Depth [pooled analysis]: This pooled analysis of five randomized controlled trials with two-year low-dose glucocorticoid interventions was performed in 12 countries in Europe in patients with early and established RA. Patients who had RA and were on low-dose glucocorticoid treatment over at least two years along with body weight measurements and blood pressure measurements were eligible for the study. Patients who did not fit these criteria were excluded from the study. The primary outcome measured was body weight in kilograms and mean arterial pressure (MAP). Outcomes in the primary analysis were assessed via analyses of covariance with a model containing the following terms: treatment (two levels), baseline value of the outcome (one for each participant), and trial identifier (five levels). Based on the primary analysis, glucocorticoids led, on average, to 1.1 kg (95% Confidence Interval [CI], 0.4 to 1.8 kg; p<0.001) more weight gain than the control treatment. MAP increased by about 2mmHg in both groups, with a between-group difference of -0.4 mm Hg (95% CI, -3.0 to 2.2mmHg), though the changes were not statistically significant. In summary, this study demonstrates that low-dose glucocorticoid treatment for over two years in the management of RA does not affect blood pressure but does cause a small weight gain of about one kilogram.

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