scholarly journals Prevalence of hospital PCR-confirmed COVID-19 cases in patients with chronic inflammatory and autoimmune rheumatic diseases

2020 ◽  
Vol 79 (9) ◽  
pp. 1170-1173 ◽  
Author(s):  
Jose L Pablos ◽  
Lydia Abasolo ◽  
Jose M Alvaro-Gracia ◽  
Francisco J Blanco ◽  
Ricardo Blanco ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Inflammatory Diseases ◽  
Age Distribution ◽  
Reference Population ◽  
Disease Modifying Antirheumatic Drugs ◽  
Immune Mediated ◽  
Synthetic Dmards ◽  
Specific Factors

BackgroundThe susceptibility of patients with rheumatic diseases and the risks or benefits of immunosuppressive therapies for COVID-19 are unknown.MethodsWe performed a retrospective study with patients under follow-up in rheumatology departments from seven hospitals in Spain. We matched updated databases of rheumatology patients with severe acute respiratory syndrome coronavirus 2-positive PCR tests performed in the hospital to the same reference populations. Rates of PCR+ confirmed COVID-19 were compared among groups.ResultsPatients with chronic inflammatory diseases had 1.32-fold higher prevalence of hospital PCR+ COVID-19 than the reference population (0.76% vs 0.58%). Patients with systemic autoimmune or immune-mediated disease (AI/IMID) showed a significant increase, whereas patients with inflammatory arthritis (IA) or systemic lupus erythematosus did not. COVID-19 cases in some but not all diagnostic groups had older ages than cases in the reference population. Patients with IA on targeted-synthetic or biological disease-modifying antirheumatic drugs (DMARDs), but not those on conventional-synthetic DMARDs, had a greater prevalence despite a similar age distribution.ConclusionPatients with AI/IMID show a variable risk of hospital-diagnosed COVID-19. Interplay of ageing, therapies and disease-specific factors seem to contribute. These data provide a basis to improve preventive recommendations to rheumatic patients and to analyse the specific factors involved in COVID-19 susceptibility.

scholarly journals Prevalence of Hospital PCR Confirmed COVID-19 Cases in Patients with Chronic Inflammatory and Autoimmune Rheumatic Diseases

2020 ◽  
Author(s):  
José L. Pablos ◽  
Lydia Abasolo-Alcázar ◽  
José M. Álvaro-Gracia ◽  
Francisco J. Blanco ◽  
Ricardo Blanco ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Inflammatory Diseases ◽  
Age Distribution ◽  
Reference Population ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Immune Mediated ◽  
Specific Factors

ABSTRACTBackgroundThe susceptibility of patients with rheumatic diseases, and the risks or benefits of immunosuppressive therapies for COVID-19 are unknown.MethodsWe performed a retrospective study with patients under follow-up in rheumatology departments from seven hospitals in Spain. We matched updated databases of rheumatology patients with SARS-CoV-2 positive PCR tests performed in the hospital to the same reference populations. Rates of PCR+ confirmed COVID-19 were compared among groups.ResultsPatients with chronic inflammatory diseases had 1.32-fold higher prevalence of hospital PCR+ COVID-19 than the reference population (0.76% vs 0.58%). Systemic autoimmune or immune mediated diseases (AI/IMID) patients showed a significant increase, whereas inflammatory arthritis (IA) or systemic lupus erythematosus (SLE) patients did not. COVID-19 cases in some but not all diagnostic groups had older ages than cases in the reference population. IA patients on targeted-synthetic or biological disease-modifying antirheumatic drugs (ts/bDMARD), but not those on conventional-synthetic (csDMARD), had a greater prevalence despite a similar age distribution.ConclusionPatients with AI/IMID show a variable risk of hospital diagnosed COVID-19. Interplay of aging, therapies, and disease specific factors seem to contribute. These data provide a basis to improve preventive recommendations to rheumatic patients and to analyze the specific factors involved in COVID-19 susceptibility.

scholarly journals AB0430 CONTRIBUTION OF SCLERODERMA/MYOSITIS-RELATED ANTIBODIES DETECTED BY IMMUNOBLOT TO THE DIAGNOSIS OF SYSTEMIC AUTOIMMUNE RHEUMATIC DISEASES IN 134 PATIENTS FROM A SINGLE REFERRAL CENTER

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1243.2-1244
Author(s):  
D. Prieto-Peña ◽  
B. Atienza-Mateo ◽  
M. A. González-Gay ◽  
R. Blanco ◽  
M. Lopez-Hoyos
Keyword(s):  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Medical Records ◽  
Inflammatory Diseases ◽  
Clinical Suspicion ◽  
Autoimmune Rheumatic Diseases ◽  
High Clinical Suspicion ◽  
Necrotizing Myositis ◽  
Specific Symptoms

Background:Immunoblot assays are increasingly used in clinical practice as part of the diagnostic armamentarium of systemic autoimmune rheumatic diseases (SARDs).Objectives:To assess the contribution of an extended scleroderma/myositis-related antibodies (Ab) determination by immunoblot to the diagnosis of patients with SARDs.Methods:We reviewed all medical records of patients with positive scleroderma/myositis-related Ab line blot determinations (Euroimmune AG, Lübeck, Germany) in our center from November 2017 to September 2020. These assays were requested due to high suspicion of SARDs in patients presenting with non-specific symptoms.Results:134 patients (37men/97women; mean age 59.6 ± 14.8 years) were positive for at least 1 Ab, 25 of them were positive for 2 Abs. Main clinical features at the time of immunoblot requests were: arthralgia/arthritis (n=88), Raynaud’s phenomenon (n=59), rash (n=27), sicca syndrome (n=14.9%), myopathy (n=18). During follow-up, 28 patients were diagnosed with undifferentiated connective tissue disease (UCTD), 26 scleroderma, 23 overlap myositis, 18 interstitial pneumonia with autoimmune features (IPAF), 8 other inflammatory diseases, 8 Sjögren’s syndrome, 7 systemic lupus erythematosus, 5 dermatomyositis, 1 necrotizing myositis. In 10 patients the diagnosis of SARD was finally ruled out (Figure 1). Interstitial lung disease (ILD) was present in 50 patients, being particularly frequent in those with anti-PL12, anti-PL7 and anti-MDA5 Abs. Cancer was detected in 9 (6.7%) patients, 6 of them were anti-Ro52 + (Table 1).Conclusion:Immunoblot assays are of great help in the diagnosis of patients with high clinical suspicion of SARDs. While some Abs, such as anti-Ro52, anti-Ku and anti-PMScl75/100, remain to be nonspecific, other Abs including anti-PL12, anti-PL7 or anti-MDA5 are particularly helpful in detecting SARDs patients with associated ILD.References:Table 1.Mi-2 (n=5)PL-7(n=6)PL-12(n=4)Jo-1(n=6)MDA5(n=1)antiRo52(n=57)SRP (n=3)Scl-70(n=12)CENP(n=14)Th(n=2)Ku(n=14)Fibrilarina (n=2)PM-Scl75/100 (n=23)NOR90(n=8)RNA pol(n=2)ILD04 (66.7)4 (100)3 (50)1 (100)19 (33.3)07 (58.3)1 (7.1)07 (50)1 (50)9 (39.1)5 (62.5)0Cancer1 (20)00006 (10.5)1 (33.3)0001 (7.1)0000Disclosure of Interests:None declared

scholarly journals O21 The incidence of COVID-19 among children with rheumatic diseases receiving biological agents

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Nadezhda Tsurikova ◽  
Elena Ligostaeva ◽  
Vadim Avdeenko ◽  
Nataliya Kobzeva ◽  
Irina Tsiganok ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Biological Agents ◽  
Tnf Receptor ◽  
The Past ◽  
Different Types ◽  
Mediterranean Fever ◽  
Positive Results ◽  
Single Center Observational Study

Abstract Background/Aims  During the COVID-19 pandemic, analysis of the incidence of COVID-19 among patients suffering from rheumatic diseases and receiving therapy with biological agents remains relevant. Methods  This single-center observational study included 118 children suffering from various rheumatic diseases and receiving therapy with anti-rheumatic drugs and biological agents. In this research, we analyzed the incidence of CIVID-19 and the frequency of documented contact with SARS-CoV-2 in the period from 01.03.2020 to 11.10.2020 (32 weeks). The results were analyzed using descriptive statistics. Results  Among 118 children, there were 28 (24%) boys and 90 (76%) girls, average age 10.3±4.2. 104 (88.2%) patients had different types of juvenile idiopathic arthritis (JIA), 2 (1.6%) children had systemic lupus erythematosus (SLE), 2 (1.6%) patients had juvenile dermatomyositis (JDM), 1 (1%) child had ANCA-associated vasculitis, 6 (5%) patients had familial Mediterranean fever (FMF), 2 (1.6%) children had deficiency of adenosine deaminase 2 (DADA2), 1 (1%) child had TNF receptor-associated periodic syndrome (TRAPS). In this group of patients 94 (79%) patients were treated with methotrexate, 1 (1%) - azathioprine, 3 (2%) patients received hydroxychloroquine, 6(5%) - mycophenolate mofetil, 4 (3%) - sulfasalazine, 14(11%) children received prednisone, 6(5%) - cyclosporine A. All children included in this study received biological agents for more than 1 year, the distribution of biological agents among patients was as follows: 41(34%) - etanercept, 33(28%) - adalimumab, 24 (20%) - tocilizumab, 7 (6%) - canakinumab, 3 (2%) - abatacept, 4 (3%) - golimumab, 6 (5%) - rituximab. Out of 118 children, 4 (3%) patients had flu-like symptoms and positive results of PCR tests for COVID-19 (1 patient was treated with etanercept, 1 - adalimumab, 1 - tocilizumab, 1 - rituximab), none of the patients had signs of SARS-CoV-2 pneumonia. 10 (8%) patients had documented contact with COVID-19: among this patients 2 children had flu-like symptoms, positive results of PCR tests and absence of COVID-19 pneumonia (one of this patient was treated with adalimumab, another one - with rituximab), one more patient was treated with tocilizumab and had positive PCR test without any symptoms of COVID-19; other 7 children had negative PCR tests and didn’t have any signs of COVID-19. Conclusion  Among our patients with various rheumatic diseases treated with biological agents there were no registered severe cases of COVID-19. Over the past period (32 weeks of follow-up) 3% of children with COVID-19 were identified and 8% patients had documented contact with COVID-19, but we suppose it is too early to make conclusions about the degree and severity of COVID-19 among children suffering from rheumatic diseases and receiving various biological agents. Further follow-up is needed to better understand the risk and impact of COVID-19 among children with rheumatic diseases and receiving therapy with biological agents. Disclosure  N. Tsurikova: None. E. Ligostaeva: None. V. Avdeenko: None. N. Kobzeva: None. I. Tsiganok: None. K. Skorobogatova: None. A. Motkina: None.

scholarly journals Flares in patients with systemic lupus erythematosus

Rheumatology ◽  
2020 ◽  
Author(s):  
Kathleen McElhone ◽  
Janice Abbott ◽  
Margaret Hurley ◽  
Jane Burnell ◽  
Peter Lanyon ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Trial Design ◽  
Disease Duration ◽  
Clinical Trial Design ◽  
Reference Population ◽  
World Population ◽  
Future Clinical Trial ◽  
Systemic Lupus

Abstract Objective SLE is characterized by relapses and remissions. We aimed to describe the frequency, type and time to flare in a cohort of SLE patients. Methods SLE patients with one or more ‘A’ or ‘B’ BILAG-2004 systems meeting flare criteria (‘new’ or ‘worse’ items) and requiring an increase in immunosuppression were recruited from nine UK centres and assessed at baseline and monthly for 9 months. Subsequent flares were defined as: severe (any ‘A’ irrespective of number of ‘B’ flares), moderate (two or more ‘B’ without any ‘A’ flares) and mild (one ‘B’). Results Of the 100 patients, 94% were female, 61% White Caucasians, mean age (s.d.) was 40.7 years (12.7) and mean disease duration (s.d.) was 9.3 years (8.1). A total of 195 flares re-occurred in 76 patients over 781 monthly assessments (flare rate of 0.25/patient-month). There were 37 severe flares, 32 moderate flares and 126 mild flares. By 1 month, 22% had a mild/moderate/severe flare and 22% had a severe flare by 7 months. The median time to any ‘A’ or ‘B’ flare was 4 months. Severe/moderate flares tended to be in the system(s) affected at baseline, whereas mild flares could affect any system. Conclusion . In a population with active SLE we observed an ongoing rate of flares from early in the follow-up period with moderate–severe flares being due to an inability to fully control the disease. This real-world population study demonstrates the limitations of current treatments and provides a useful reference population from which to inform future clinical trial design.

scholarly journals Ganglionic Acetylcholine Receptor Antibodies and Autonomic Dysfunction in Autoimmune Rheumatic Diseases

2020 ◽  
Vol 21 (4) ◽  
pp. 1332 ◽  
Author(s):  
Michie Imamura ◽  
Akihiro Mukaino ◽  
Koutaro Takamatsu ◽  
Hiroto Tsuboi ◽  
Osamu Higuchi ◽  
...  
Keyword(s):  
Autonomic Dysfunction ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Acetylcholine Receptors ◽  
Case Reports ◽  
Pathophysiological Mechanism ◽  
Autoimmune Rheumatic Diseases ◽  
Immune Mediated ◽  
Autonomic Disturbance ◽  
Antibody Levels

Autonomic neuropathy has been reported in autoimmune rheumatic diseases (ARD) including Sjögren’s syndrome, systemic sclerosis, rheumatoid arthritis, and systemic lupus erythematosus. However, the pathophysiological mechanism underlying autonomic dysfunction remains unknown to researchers. On the other hand, autoimmune autonomic ganglionopathy (AAG) is an acquired immune-mediated disorder, which causes dysautonomia that is mediated by autoantibodies against ganglionic acetylcholine receptors (gAChRs). The purpose of this review was to describe the characteristics of autonomic disturbance through previous case reports and the functional tests used in these studies and address the importance of anti-gAChR antibodies. We have established luciferase immunoprecipitation systems to detect antibodies against gAChR in the past and determined the prevalence of gAChR antibodies in various autoimmune diseases including AAG and rheumatic diseases. Autonomic dysfunction, which affects lower parasympathetic and higher sympathetic activity, is usually observed in ARD. The anti-gAChR antibodies may play a crucial role in autonomic dysfunction observed in ARD. Further studies are necessary to determine whether anti-gAChR antibody levels are correlated with the severity of autonomic dysfunction in ARD.

scholarly journals Intraoperative periprosthetic fractures during total hip arthroplasty in patients with rheumatic diseases

2019 ◽  
Vol 56 (6) ◽  
pp. 791-796 ◽  
Author(s):  
A. E. Khramov ◽  
M. A. Makarov ◽  
S. A. Makarov ◽  
V. N. Amirdzhanova ◽  
A. V. Rybnikov ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Hip Arthroplasty ◽  
Rheumatic Diseases ◽  
Hip Arthroplasty ◽  
Lupus Erythematosus ◽  
Inflammatory Diseases ◽  
Intraoperative Complications ◽  
Periprosthetic Fractures ◽  
Term Therapy ◽  
Total Hip

Surgical treatment in patients with rheumatic diseases (RDs) is associated with the higher risk of complications due to the presence of the inflammatory process, to long-term therapy with glucocorticoids, disease-modifying antirheumatic drugs, and biologic agents (BA), to decreased physical activity, and the severity of functional disorders, and to obvious osteoporosis. All this increases the risk of intraoperative complications, including periprosthetic fractures.Objective: to comparatively analyze intraoperative periprosthetic fractures of the greater trochanter, acetabulum, and proximal femur during total hip arthroplasty (THA) in patients with RDs.Subjects and methods. From 1998 till 2017, a total of 1569 THA were performed in patients with RA, including 464 patients with rheumatoid arthritis (RA), 396 with juvenile rheumatoid arthritis (JRA) and systemic lupus erythematosus (SLE), and 709 with osteoarthritis (OA).Results and discussion. Periprosthetic fractures after THA were diagnosed in a total of 68 (4.33%) patients, including 23 (4.96%) patients with RA, 27 (6.82%) with JRA and SLE, and 18 (2.54%) with OA; 42 (61.8%) patients with periprosthetic fractures underwent osteosynthesis. Statistical analysis of the findings revealed significantly higher rates of complications in patients with RA and JRA with SLE (p < 0.005).Conclusion. The findings confirm that the risk of periprosthetic fractures is higher in patients with inflammatory diseases, including RA, JRA, and SLE. These patients require a special approach that involves medical correction of impaired bone metabolism and proper individual selection of endoprosthetic components, by taking into account the anatomical features of female patients and delicate bone handling during surgery.

scholarly journals Dose-dependent oral glucocorticoid cardiovascular risk in people with immune-mediated inflammatory diseases

2020 ◽  
Author(s):  
Mar Pujades-Rodriguez ◽  
Ann W Morgan ◽  
Richard M Cubbon ◽  
Jianhua Wu
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Systemic Lupus Erythematosus ◽  
Acute Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Lupus Erythematosus ◽  
Inflammatory Diseases ◽  
Systemic Lupus ◽  
Immune Mediated ◽  
Dose Dependent

ABSTRACTBackgroundEvidence for the association between glucocorticoid dose and cardiovascular risk is weak for moderate and low doses. To quantify glucocorticoid dose-dependent cardiovascular risk in people with six immune-mediated inflammatory diseases.Methods and FindingsPopulation-based cohort analysis of medical records from 389 primary care practices contributing data to the UK Clinical Practice Research Datalink, linked to hospital admissions and deaths in 1998-2017. There were 87,794 patients with giant cell arteritis and/or polymyalgia rheumatica (n=25,581), inflammatory bowel disease (n=27,739), rheumatoid arthritis (n=25,324), systemic lupus erythematosus (n=3951), and/or vasculitis (n=5199); and no prior cardiovascular disease (CVD). Mean age was 56 years and 34.1% were men. Median follow-up time was 5.0 years. Time-variant daily and cumulative glucocorticoid prednisolone-equivalent dose-related risks and hazard ratios of first all-cause and type-specific CVD.We found 13,426 (15.3%) people with incident CVD, including 6,013 atrial fibrillation, 7,727 heart failure and 2,809 acute myocardial infarction events. At 1 and 5 years, the cumulative risks of all-cause CVD increased from 1.5% in periods of non-use to 9.1% for a daily prednisolone-equivalent dose of ≥25.0mg, and from 7.6% to 29.9%, respectively. We found strong dose-dependent estimates for all immune-mediated diseases (hazard ratio [HR] for <5.0mg daily dose vs. non-use=1.74, 95%CI 1.64-1.84; range 1.52 for polymyalgia rheumatica and/or giant cell arteritis to 2.82 for systemic lupus erythematosus), all cardiovascular outcomes, regardless of disease activity level. The highest estimates were for heart failure and acute myocardial infarction.ConclusionsWe estimated glucocorticoid dose-dependent cardiovascular risk in six immune-mediated diseases. Results highlight the importance of prompt and regular monitoring of cardiovascular risk and use of primary prevention treatment at all glucocorticoid doses.

scholarly journals A Brazilian Cohort of Patients With Immuno-Mediated Chronic Inflammatory Diseases Infected by SARS-CoV-2 (ReumaCoV-Brasil Registry): Protocol for a Prospective, Observational Study

10.2196/24357 ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. e24357
Author(s):  
Claudia Marques ◽  
Adriana Maria Kakehasi ◽  
Ana Paula Monteiro Gomides ◽  
Eduardo Dos Santos Paiva ◽  
Edgard Torres dos Reis Neto ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Inflammatory Diseases ◽  
Progression Rate ◽  
Immune Mediated ◽  
Increased Risk ◽  
Observational Cohort ◽  
And Function ◽  
The Impact ◽  
Brazilian Cohort

Background Patients with immune-mediated rheumatic diseases (IMRD) are at increased risk of infections, including significant morbidity and high mortality. Considering the potential for unfavorable outcomes of SARS-CoV-2 infection in patients with IMRD, several questions were raised regarding the impact of COVID-19 at the start of the pandemic. Objective This paper presents the protocol of a study that aims to prospectively evaluate patients with IMRD and a confirmed COVID-19 diagnosis (using criteria provided by the Brazilian Ministry of Health). Methods The study comprised a prospective, observational cohort (patients with IMRD and COVID-19) and a comparison group (patients with only IMRD), with a follow-up time of 6 months to evaluate differences in health outcomes. The primary outcomes will be changes in IMRD disease activity after SARS-CoV-2 infection at 4 time points: (1) at baseline, (2) within 4-6 weeks after infection, (3) at 3 months after the second assessment (±15 days), and (4) at 6 months (±15 days). The secondary outcomes will be the progression rate to moderate or severe forms of COVID-19, need for intensive care unit admission and mechanical ventilation, death, and therapeutic changes related to IMRD. Two outcomes—pulmonary and thromboembolic events in patients with both IMRD and SARS-CoV-2 infection—are of particular interest and will be monitored with close attention (clinical, laboratory, and function tests as well as imaging). Results Recruitment opened in May 2020, with 1300 participants recruited from 43 sites as of November 2020. Patient recruitment will conclude by the end of December 2020, with follow-up occurring until April 2021. Data analysis is scheduled to start after all inclusion data have been collected, with an aim to publish a peer-reviewed paper in December 2020. Conclusions We believe this study will provide clinically relevant data on the general impact of COVID-19 on patients with IMRD. Trial Registration Brazilian Registry of Clinical Trials RBR-33YTQC; http://www.ensaiosclinicos.gov.br/rg/RBR-33ytqc/ International Registered Report Identifier (IRRID) DERR1-10.2196/24357

scholarly journals Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: A population-based cohort study

PLoS Medicine ◽  
2020 ◽  
Vol 17 (12) ◽  
pp. e1003432 ◽  
Author(s):  
Mar Pujades-Rodriguez ◽  
Ann W. Morgan ◽  
Richard M. Cubbon ◽  
Jianhua Wu
Keyword(s):  
Cardiovascular Risk ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Inflammatory Diseases ◽  
Population Based ◽  
Equivalent Dose ◽  
Systemic Lupus ◽  
Immune Mediated ◽  
Cumulative Risks ◽  
Dose Dependent

Background Glucocorticoids are widely used to reduce disease activity and inflammation in patients with a range of immune-mediated inflammatory diseases. It is uncertain whether or not low to moderate glucocorticoid dose increases cardiovascular risk. We aimed to quantify glucocorticoid dose-dependent cardiovascular risk in people with 6 immune-mediated inflammatory diseases. Methods and findings We conducted a population-based cohort analysis of medical records from 389 primary care practices contributing data to the United Kingdom Clinical Practice Research Datalink (CPRD), linked to hospital admissions and deaths in 1998–2017. We estimated time-variant daily and cumulative glucocorticoid prednisolone-equivalent dose-related risks and hazard ratios (HRs) of first all-cause and type-specific cardiovascular diseases (CVDs). There were 87,794 patients with giant cell arteritis and/or polymyalgia rheumatica (n = 25,581), inflammatory bowel disease (n = 27,739), rheumatoid arthritis (n = 25,324), systemic lupus erythematosus (n = 3,951), and/or vasculitis (n = 5,199), and no prior CVD. Mean age was 56 years and 34.1% were men. The median follow-up time was 5.0 years, and the proportions of person–years spent at each level of glucocorticoid daily exposure were 80% for non-use, 6.0% for <5 mg, 11.2% for 5.0–14.9 mg, 1.6% for 15.0–24.9 mg, and 1.2% for ≥25.0 mg. Incident CVD occurred in 13,426 (15.3%) people, including 6,013 atrial fibrillation, 7,727 heart failure, and 2,809 acute myocardial infarction events. One-year cumulative risks of all-cause CVD increased from 1.4% in periods of non-use to 8.9% for a daily prednisolone-equivalent dose of ≥25.0 mg. Five-year cumulative risks increased from 7.1% to 28.0%, respectively. Compared to periods of non-glucocorticoid use, those with <5.0 mg daily prednisolone-equivalent dose had increased all-cause CVD risk (HR = 1.74; 95% confidence interval [CI] 1.64–1.84; range 1.52 for polymyalgia rheumatica and/or giant cell arteritis to 2.82 for systemic lupus erythematosus). Increased dose-dependent risk ratios were found regardless of disease activity level and for all type-specific CVDs. HRs for type-specific CVDs and <5.0-mg daily dose use were: 1.69 (95% CI 1.54–1.85) for atrial fibrillation, 1.75 (95% CI 1.56–1.97) for heart failure, 1.76 (95% CI 1.51–2.05) for acute myocardial infarction, 1.78 (95% CI 1.53–2.07) for peripheral arterial disease, 1.32 (95% CI 1.15–1.50) for cerebrovascular disease, and 1.93 (95% CI 1.47–2.53) for abdominal aortic aneurysm. The lack of hospital medication records and drug adherence data might have led to underestimation of the dose prescribed when specialists provided care and overestimation of the dose taken during periods of low disease activity. The resulting dose misclassification in some patients is likely to have reduced the size of dose–response estimates. Conclusions In this study, we observed an increased risk of CVDs associated with glucocorticoid dose intake even at lower doses (<5 mg) in 6 immune-mediated diseases. These results highlight the importance of prompt and regular monitoring of cardiovascular risk and use of primary prevention treatment at all glucocorticoid doses.

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