EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases

Abstract

Objective: To develop evidence-based recommendations for the management of systemic glucocorticoid (GC) therapy in rheumatic diseases. Methods: The multidisciplinary guideline development group from 11 European countries, Canada and the USA consisted of 15 rheumatologists, 1 internist, 1 rheumatologist-epidemiologist, 1 health professional, 1 patient and 1 research fellow. The Delphi method was used to agree on 10 key propositions related to the safe use of GCs. A systematic literature search of PUBMED, EMBASE, CINAHL, and Cochrane Library was then used to identify the best available research evidence to support each of the 10 propositions. The strength of recommendation was given according to research evidence, clinical expertise and perceived patient preference. Results: The 10 propositions were generated through three Delphi rounds and included patient education, risk factors, adverse effects, concomitant therapy (ie, non-steroidal anti-inflammatory drugs, gastroprotection and cyclo-oxygenase-2 selective inhibitors, calcium and vitamin D, bisphosphonates) and special safety advice (ie, adrenal insufficiency, pregnancy, growth impairment). Conclusion: Ten key recommendations for the management of systemic GC-therapy were formulated using a combination of systematically retrieved research evidence and expert consensus. There are areas of importance that have little evidence (ie, dosing and tapering strategies, timing, risk factors and monitoring for adverse effects, perioperative GC-replacement) and need further research; therefore also a research agenda was composed.

2015 Recommendations for the Management of Polymyalgia Rheumatica: A European League Against Rheumatism/American College of Rheumatology Collaborative Initiative

“…Baseline factors that were associated in low to moderate quality studies with a higher relapse rate and/or prolonged therapy in PMR studies were: female sex (24,26), high ESR (.40 mm/hour) (26)(27)(28)(29)(30)(31) and peripheral inflammatory arthritis (32). A number of equally low to moderate quality studies, however, failed to demonstrate an association between these factors and relapse/prolonged therapy (27)(28)(29)(30)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). C. Consideration of specialist referral, particularly in case of atypical presentation (such as peripheral inflammatory arthritis, systemic symptoms, low inflammatory markers, age ,60 years), experience of or high risk of therapy-related side effects, PMR refractory to GC therapy, and/or relapses/prolonged therapy.…”

The Prediction and Monitoring of Toxicity Associated with Long-Term Systemic Glucocorticoid Therapy

“…Previous EULAR recommendations advise baseline screening and ongoing monitoring for both cataract and glaucoma in patients receiving GCs for rheumatic disease [ 39 ], but for low-dose GC therapy only baseline screening for glaucoma is recommended [ 15 ]. For patients with systemic lupus erythematosus (SLE) receiving long-term GC therapy, at least a baseline eye assessment is recommended [ 40 ].…”

Psychiatric Illness of Systemic Lupus Erythematosus in Childhood: Spectrum of Clinically Important Manifestations

“…Кроме того, ГК и гидрокси-хлорохин, которые наиболее часто используются в лечении СКВ, могут индуцировать поражение глаз [71][72][73]. Все вы-шеизложенное обусловливает необходимость регулярного офтальмологического контроля.…”