Current use of glucocorticoids in patients with rheumatoid arthritis in Germany

Abstract

Objective. To describe the current use of glucocorticoids in German patients with rheumatoid arthritis (RA). Methods. We analyzed clinical and patient-derived data from 10,068 outpatients with RA from the national database of the German Collaborative Arthritis Centres for the year 2001 collected by more than 80 rheumatologists in hospitals and private practices. Results. Systemic glucocorticoid therapy was prescribed for 60% of all patients with RA in rheumatologic care. The proportion of patients receiving systemic glucocorticoids in addition to disease-modifying antirheumatic drug (DMARD) therapy ranged from 53% to 81% of the patients for the various DMARDs. Glucocorticoid therapy was administered more often in combination with tumor necrosis factor inhibitors (81%), cyclosporin A (80%), or leflunomide (77%) than with more traditional DMARDs such as methotrexate (63%) or sulfasalazine (55%). Regarding the prevention and treatment of osteoporosis, 63% of patients taking systemic glucocorticoids were also receiving some type of osteoporosis therapy, as opposed to only 26% of those not taking glucocorticoids. Conclusion. Glucocorticoids play a pivotal role in the management of RA. This is reflected in the extensive use of low-dose glucocorticoids by German rheumatologists. Even if highly effective DMARDs are prescribed, they are accompanied by glucocorticoids, at least in the initial phase. High-dose glucocorticoids are prescribed for only a small proportion of the patients. There is increasing awareness of the risk of osteoporosis in long-term glucocorticoid treatment, demonstrated by the fact that osteoporosis medication is prescribed for a large proportion of patients taking glucocorticoids.

Glucocorticoid treatment and endocrine pancreas function: implications for glucose homeostasis, insulin resistance and diabetes

“…Inhaled GCs are used to treat allergic reactions in airways and to dampen bronchial hyperreactivity in asthma. Systemically, GCs are used to combat connective tissue inflammation, rheumatoid arthritis, bowel diseases and in allotransplantation (Thiele et al 2005).…”

Rheumatoid Arthritis in the Russian Federation According to Russian Arthritis Registry Data (Communication I)

“…Согласно материалам регистра ОРЕЛ, примерно по-ловина пациентов с РА принимают ГК. Это соответствует данным клинических исследований и национальных реги-стров о том, что в различные периоды болезни ГК назнача-лись 40-80% пациентов [79,[94][95][96][97]. Однако место ГК в ле-чении РА, в первую очередь в отношении влияния на отда-ленный прогноз, требует дальнейшего изучения [98].…”

Glucocorticoids

“…They are powerful and cost-effective drugs with strong anti-infl ammatory and immunomodulatory effects that are used to treat rheumatic and other diseases. Their therapeutic use has increased continuously in recent years (1,2). Furthermore, our understanding of the action of glucocorticoids has advanced in recent years, especially with regard to mechanisms of action, clinical usage, side-effect potential, and the development of new glucocorticoid drugs (2)(3)(4)(5).…”