Low-Dose Glucocorticoids in RA Linked to Modest Weight Gain, but Not Hypertension

In patients with rheumatoid arthritis (RA), the use of low-dose glucocorticoids over a span of two years has been found to lead to a slight increase in weight, around 1 kg more than control groups. However, this treatment did not result in an increase in blood pressure, according to a study published in the Annals of Internal Medicine by Andriko Palmowski, MD, Department of Rheumatology and Clinical Immunology and colleagues.

Glucocorticoids, commonly prescribed to manage RA by reducing disease activity and slowing joint damage, are associated with various adverse effects, including weight gain and hypertension, particularly when administered at higher doses over extended periods.

A pooled analysis of five randomized controlled trials (RCTs) was conducted, utilizing data from 12 European countries. These trials included patients with early and established RA who received low-dose glucocorticoids (≤7.5 mg prednisone equivalent per day) for a duration of two years, alongside a control group. Patients were also allowed to receive other disease-modifying antirheumatic drug (DMARD) treatments.

The primary focus was on changes in body weight and mean arterial pressure from baseline. Additionally, the study assessed any difference in the change in the number of antihypertensive drugs used after two years of glucocorticoid treatment. Subgroup and sensitivity analyses were employed to strengthen the primary findings.

• The study encompassed 1,112 participants, with an average age of 61.4 years, of whom 68% were women.

• Most trials (n = 4) were conducted in a blinded manner, and controls were administered placebo treatments.

• While both intervention and control groups exhibited weight gain, patients treated with low-dose glucocorticoids gained an average of 1.1 kg more (95% confidence interval [CI], 0.4 to 1.8 kg; P < 0.001) compared to controls.

• Mean arterial pressure increased by approximately 2 mm Hg in both groups, with a difference of 0.4 mm Hg (CI, -3.0 to 2.2 mm Hg) between the two cohorts.

• No significant difference was observed between groups regarding the number of antihypertensive drugs.

This study highlights that in patients with rheumatoid arthritis, low-dose glucocorticoid treatment over two years leads to a modest increase in weight, but does not contribute to higher blood pressure. While the results provide valuable insights into the effects of glucocorticoid treatment, the study authors acknowledge limitations such as the heterogeneity of trials and potential lack of generalizability to the broader RA population. Nevertheless, the study's findings contribute to a better understanding of the complex interplay between treatment options and their impact on patients with RA.

Reference:

Palmowski A, Nielsen SM, Boyadzhieva Z, et al. The Effect of Low-Dose Glucocorticoids Over Two Years on Weight and Blood Pressure in Rheumatoid Arthritis: Individual Patient Data From Five Randomized Trials [published online ahead of print, 2023 Aug 15]. Ann Intern Med. 2023;10.7326/M23-0192. https://www.hcplive.com/view/low-dose-glucocorticoids-lead-to-modest-weight-gain-in-ra.