Three Months of Glucocorticoids in Rheumatoid Arthritis: A Bridge Too Short?

Abstract

Since their invention, glucocorticoids (GCs) have always been regarded as special. Hailed as a "miracle drug" after Philip S. Hench demonstrated astonishing effects in a patient with severe rheumatoid arthritis (RA) in 1948, pioneering physicians quickly realized that extended therapy with high doses carried a high risk of adverse events (AEs). Hench received his Nobel prize only 2 years later (1), and in his acceptance lecture he enumerated a comprehensive list of AEs before proposing a sensible approach and introducing low-dose therapy:"Physicians who would use these hormones should become familiar with these possible side effects and with certain measures devised for their prevention, modification or control. Because of their potential effects, cortisone or adrenocorticotropic hormone should be used with caution in the following: hypertensive cardiovascular disease, diabetes mellitus, tuberculosis, old rheumatic carditis with decompensation, latent or frank psychoses, marked osteoporosis associated with senility or with rheumatoid arthritis, and peptic ulcers. Certain measures have been devised to prevent or modify some of the undesirable effects. These include […] early reduction of the initial suppressive doses to lower 'maintenance doses' in all cases in which use of the hormones is prolonged. […] During the past few months we have been using smaller suppressive and smaller maintenance doses than we used previously; results have been generally quite satisfactory and will be reported elsewhere." (1)

Viewpoint: Glucocorticoids in the treatment of rheumatoid arthritis: points to (re)consider

“…Finally, the recent CORRA trial showed that GC bridging with an initial dose of 60 mg/day, tapered to zero in 3 months, briefly suppressed disease activity but had no effect on damage progression at 1 year compared with MTX monotherapy [ 31 ]. In other words, bridging protocols with a maximum period of 3 months as recommended by the EULAR are suboptimal [ 32 ].…”