Benefits and risks of low-dose glucocorticoid treatment in the patient with rheumatoid arthritis

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.

A randomized controlled trial of methotrexate for patients with generalized myasthenia gravis

“…24 Even long-term low-dose glucocorticoid use is associated with typical steroidrelated adverse events. 25 Thus there has been interest in finding a steroid-sparing therapy for MG, but less success in demonstrating effectiveness of one.…”

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

“…Even treatment with low-dose steroids is associated with weight gain, hyperglycaemia, diabetes mellitus, increased blood pressure and hypertension, decreased bone mineral density with increased risk of fracture, cognitive dysfunction, increased risk of infection and cataracts. 91 The economic analysis focused on those AEs that were reported to have a high-cost impact or a detrimental effect on quality of life and that were clearly attributable to the use of steroids (as opposed to possibly arising, at least in part, as a result of having GCA). The AEs included in the model were fractures, diabetes mellitus and hyperglycaemia, symptomatic steroid myopathy and steroid psychosis.…”

Quality of Life in Rheumatoid Arthritis patients taking combination DMARDs

“…A study done by Kavanaugh A et al, have proved the efficacy for radiological and clinical outcomes for low-dose corticosteroids (defined as ≤10 mg/day prednisone equivalent) in the treatment of RA. [39] In the present study , deflazacort was used at a dose of 3 -6 mg along with study drugs which is comparable to above mentioned study. According to EULAR, in early RA, addition of low dose corticosteroids (< 7.5 mg/day) to DMARDs will lead to a significant reduction to radiographic progression and chronic use of corticosteroids in a dose up to 15 mg/day will improve disease activity.…”