Glucocorticoid treatment in patients with inflammatory rheumatic diseases: current practice and open questions - PubMed
6 hours ago
- #Glucocorticoids
- #Treatment Guidelines
- #Rheumatic Diseases
- Glucocorticoids are a cornerstone treatment for inflammatory rheumatic diseases due to rapid, potent anti-inflammatory effects.
- Long-term glucocorticoid use carries risks of cumulative toxicity, and international consensus advises lowest effective dose, shortest duration, and discontinuation when feasible.
- Guidelines for rheumatoid arthritis, systemic lupus erythematosus, and polymyalgia rheumatica recommend short-term glucocorticoid use as bridging therapy at the lowest effective dose.
- Registry and cohort data show chronic glucocorticoid therapy (>6 months) remains common due to difficult-to-treat disease, flares, limited access to alternatives, and reluctance to discontinue.
- New evidence suggests longer-term glucocorticoid therapy with very low doses (<5 mg/day) under careful monitoring may have an acceptable safety profile, though risks persist.
- Rational strategies combining disease-modifying antirheumatic drugs with very low-dose glucocorticoids might improve outcomes, reduce flares, and help overcome the ceiling effect in rheumatoid arthritis.
- The review summarizes current recommendations, highlights gaps between guidelines and practice, and discusses optimal approaches for glucocorticoid reduction, discontinuation, and potential safe long-term low-dose use.