The safety of glucocorticoids in the treatment of inflammatory rheumatic disease: new evidence

Mariana Luís, Maarten Boers, Ken Saag, Frank Buttgereit, José A. P. da Silva

Research output: Contribution to journalReview articleAcademicpeer-review

6 Citations (Scopus)

Abstract

Purpose of review Glucocorticoids justifiably remain a cornerstone in the treatment of many inflammatory rheumatic diseases but many are opposed to their use because of the side effects, most of them known to be dose-dependent. Most concerns regarding glucocorticoids stem from observational studies which are affected by several forms of bias, mainly confounding by indication, that may result in overestimation of harm. Solid evidence regarding the safety of low-dose glucocorticoids remains remarkably scarce. Recent findings Several observational studies showed heterogeneous results and two 6-month trials showed no increase of harm. The GLORIA trial of 5mg/day prednisolone vs. placebo in patients aged 65þ is the first randomized control trial with glucocorticoids safety as coprimary outcome. The benefits of glucocorticoids in terms of symptoms and structural damage were confirmed, but the proportion of patients with at least one adverse event of special interest (serious or glucocorticoids-related) was increased by 24%, mostly due to nonsevere infections. Summary Based on current evidence the benefit-risk balance of low-dose glucocorticoids in rheumatoid arthritis, and probably in other rheumatic diseases is generally favourable. Physicians should be aware of the risks and mitigate them, but avoid the negative effects of unfounded fear.

Original languageEnglish
Pages (from-to)179-186
Number of pages8
JournalCurrent Opinion in Rheumatology
Volume34
Issue number3
DOIs
Publication statusPublished - 1 May 2022

Keywords

  • glucocorticoids
  • risk
  • safety
  • toxicity

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