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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.

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Clinical Rheumatology

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