Benefits and risks of low-dose glucocorticoid treatment in the patient with rheumatoid arthritis
Open Access
- 10 April 2014
- journal article
- review article
- Published by Oxford University Press (OUP) in Rheumatology
- Vol. 53 (10), 1742-1751
- https://doi.org/10.1093/rheumatology/keu135
Abstract
Glucocorticosteroids (GCs) have been employed extensively for the treatment of rheumatoid arthritis (RA) and other autoimmune and systemic inflammatory disorders. Their use is supported by extensive literature and their utility is reflected in their incorporation into current treatment guidelines for RA and other conditions. Nevertheless, there is still some concern regarding the long-term use of GCs because of their potential for clinically important adverse events, particularly with an extended duration of treatment and the use of high doses. This article systematically reviews the efficacy for radiological and clinical outcomes for low-dose GCs (defined as ≤10 mg/day prednisone equivalent) in the treatment of RA. Results reviewed indicated that low-dose GCs, usually administered in combination with synthetic DMARDs, most often MTX, significantly improve structural outcomes and decrease symptom severity in patients with RA. Safety data indicate that GC-associated adverse events are dose related, but still occur in patients receiving low doses of these agents. Concerns about side effects associated with GCs have prompted the development of new strategies aimed at improving safety without compromising efficacy. These include altering the structure of existing GCs and the development of delayed-release GC formulations so that drug delivery is timed to match greatest symptom severity. Optimal use of low-dose GCs has the potential to improve long-term outcomes for patients with RA.Keywords
This publication has 76 references indexed in Scilit:
- The clinical effect of glucocorticoids in patients with rheumatoid arthritis may be masked by decreased use of additional therapiesArthritis Care & Research, 2004
- Complete remission of experimental arthritis by joint targeting of glucocorticoids with long‐circulating liposomesArthritis & Rheumatism, 2003
- Low-dose glucocorticoids in early rheumatoid arthritis: discordant effects on bone mineral density and fractures?2003
- COBRA combination therapy in patients with early rheumatoid arthritis: Long‐term structural benefits of a brief interventionArthritis & Rheumatism, 2002
- Low-Dose Prednisone Therapy for Patients with Early Active Rheumatoid Arthritis: Clinical Efficacy, Disease-Modifying Properties, and Side Effects: A Randomized, Double-Blind, Placebo-Controlled Clinical TrialAnnals of Internal Medicine, 2002
- Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgeryAnnals Of The Rheumatic Diseases, 2001
- Low dose prednisolone therapy (LDPT) retards radiographically detectable destruction in early rheumatoid arthritis –Zeitschrift für Rheumatologie, 2000
- Remission and response to early treatment of RA assessed by the Disease Activity ScoreRheumatology, 2000
- Progression of radiographic joint erosion during low dose corticosteroid treatment of rheumatoid arthritis.2000
- A randomised trial of differentiated prednisolone treatment in active rheumatoid arthritis. Clinical benefits and skeletal side effectsAnnals Of The Rheumatic Diseases, 1999