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Treatment Associated Side Effects
Safe use of low-dose glucocorticoids (GCs) continues to be a hotly debated topic, largely because these agents are recognized to be limiting of joint damage and acute inflammation, while being associated with a known adverse event profile and co-morbidities such as cardiovascular events, osteoporosis, serious infections and diabetes. Recent editorials in Arthritis Care and Research (Mahajan et al.) and Annals of the Rheumatic Diseases (Buttgereit et al.) try to place the results of recent systematic reviews on this important topic – the risk-benefit of low dose glucocorticoids for treatment of RA – into context of available clinical trial and registry data. Overall, the sum of current guidelines and recommendations: there is general agreement that short-term treatment with GCs, generally 6 months or less, is an appropriate option for RA management (Strehl et al.). Recommendations for tapering are scant, and are usually along the lines of “taper to a dose ≤ 7.5mg/d as quickly as possible”. When initiating tapering for patients in remission, discontinuing GCs is recommended as a key first step (Palmowski et al.). Importantly data described in the reviews suggests that 5 mg/d or less is relatively “safe” when no other option is available. Professors Bernard Combe, Willem Lems, and Kenneth Saag highlight key aspects of this challenging topic in video interviews.
"Official View" on Glucocorticoids in Rheumatoid Arthritis: A Systematic Review of International Guidelines and Consensus Statements
Palmowski Y, Buttgereit T, Dejaco C, Bijlsma JW, Matteson EL, Voshaar M, Boers M, Buttgereit FArthritis Care Res (Hoboken). 2017 Aug; 69(8): 1134–1141
It is the Best of Treatments, It is the Worst of Treatments: The Continuing Love-Hate Relationship With Glucocorticoids in Rheumatoid Arthritis
Mahajan T, O'Dell JRArthritis Care Res (Hoboken). 2017 Aug; 69(8): 1131–1133
The Risk of Tuberculosis in Patients with Rheumatoid Arthritis Treated with Tumor Necrosis Factor-α Antagonist: A Metaanalysis of Both Randomized Controlled Trials and Registry/Cohort Studies
Jing-Wen Ai, Shu Zhang, Qiao-Ling Ruan, Yi-Qi Yu, Bing-Yan Zhang, Qi-Hui Liu, and Wen-Hong ZhangJ Rheumatol December 2015 42(12):2229-2237
Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task force
Strehl C, Bijlsma JW, de Wit M, Boers M, Caeyers N, Cutolo M, Dasgupta B, Dixon WG, Geenen R, Huizinga TW, Kent A, de Thurah AL, Listing J, Mariette X, Ray DW, Scherer HU, Seror R, Spies CM, Tarp S, Wiek D, Winthrop KL, Buttgereit FAnn Rheum Dis. 2016 Jun;75(6):952-7.
Glucocorticoid-induced osteoporosis: pathophysiological role of GH/IGF-I and PTH/VITAMIN D axes, treatment options and guidelines
Mazziotti G, Formenti AM, Adler RA, Bilezikian JP, Grossman A, Sbardella E, Minisola S, Giustina A.Endocrine. 2016 Dec;54(3):603-611. Epub 2016 Oct 20.
Hoes JN1, Bultink IE, Lems WF.Expert Opin Pharmacother. 2015 Mar;16(4):559-71
Highlights the impact of treat-to-target to limit osteopenia, and the need to proactively diagnose and manage osteoporosis in patients with active rheumatoid arthritis
Interview with Prof. Willem Lems at EULAR 2016Q. Thanks very much, Will, for joining us this morning to talk about treating difficult osteoporosis in patients with high...