Glucocorticoids in rheumatoid arthritis: the picture is shaping up

Buttgereit, Frank; Bijlsma, J. W. J.

doi:10.1136/annrheumdis-2017-211187

Cited by 20 publications

(7 citation statements)

References 17 publications

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“…In addition to their beneficial effects on reducing inflammation, GCs are also associated with many well-known adverse effects. Their use often elicits fierce debates on the benefit–risk profile 3. Among the most worrisome and unwanted effects of GC therapy is osteoporosis (OP) 4.…”

Section: Introductionmentioning

confidence: 99%

“…Their use often elicits fierce debates on the benefit–risk profile. 3 Among the most worrisome and unwanted effects of GC therapy is osteoporosis (OP). 4 Despite the common use of these drugs, now employed for the treatment of inflammatory diseases for more than 70 years, there remain many unanswered questions about their use, such as the following: is there a safe (long-term) dose for bone?…”

Section: Introductionmentioning

confidence: 99%

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Optimising both disease control and glucocorticoid dosing is essential for bone protection in patients with rheumatic disease

et al. 2022

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ObjectivesInflammatory rheumatic and musculoskeletal diseases (iRMDs) are associated with increased systemic bone loss that is mediated by chronic inflammation, treatment with glucocorticoids (GCs) and other factors. Our objective was to analyse the impact of variables that influence osteoporosis (OP) in patients with iRMD treated with GC.MethodsRh-GIOP (acronyme) is a prospective observational cohort study investigating bone health in consecutive patients with iRMD and current or prior GC treatment. We present an analysis of the patients’ baseline data here. Bone mineral density (BMD) measured by dual X-ray absorptiometry was the primary outcome. Multivariable linear regression models were performed to identify variables associated with BMD.ResultsData from 1066 patients with iRMD were analysed. GC doses of <5 mg prednisone equivalent per day, cumulative dose and duration of GC therapy were not associated with negative effects on BMD. Dosages of ≥5 mg/day lost their negative association with BMD after adjustment for confounders. When subanalysing patients with exactly 5 mg/day, no negative effect was seen. For patients with rheumatoid arthritis (RA), GC doses of >7.5 mg/day showed a negative association with BMD overall, but this effect seemed to be specific only to patients with moderate or high disease activity (Disease Activity Score 28–C reactive protein >3.2).ConclusionsGCs of ≤5 mg/day did not seem to be associated with a reduction of BMD in patients with iRMD and current or prior exposure to GC. This is most likely due to the dampening of inflammation by GC, which exerts a mitigating effect on the risk of OP. In RA, current GC doses of >7.5 mg/day were negatively associated with BMD, but only in patients with moderate to high disease activity.Trial registration numberNCT02719314.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimising both disease control and glucocorticoid dosing is essential for bone protection in patients with rheumatic disease

et al. 2022

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“…In this view of side effects, ACR recommended the short-term use of GCs in low doses and as a bridging therapy with csDMARDs. The use of GCs should be tapered as soon as csDMARDs reach their maximum effect, if clinically possible [88][89][90][91] .…”

Section: Glucocorticoids (Gcs)mentioning

confidence: 99%

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2022

IJPSR

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Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder that permanently damages and disables the joints if left untreated. Much research is being carried out; however, any detailed information that could impart knowledge of all the major aspects in an undivided form is still lacking. This review attempts to revive the existing knowledge on RA and provides comprehensive data and current information about the classification criteria for the diagnosis of rheumatoid arthritis and treatment protocol for the management of Rheumatoid arthritis. Early and accurate diagnosis is essential as it can slow down the progression of the disease, permanent joint damage and disability in up to 90% of RA patients. This article also focuses on various diagnostic modalities which help in the diagnosis of RA, and synthetic medicines available for the cure of RA. It provides a section about non-pharmacological and herbal treatment options available for the management of Rheumatoid arthritis. INTRODUCTION:Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease (the immune system mistakenly attacks the healthy tissues in joints) of unknown origin with a worldwide prevalence of 0.5-1% among adults. If not treated, RA predominately affects the joints and characterized by synovitis, systemic inflammation (triggered by metabolites of arachidonic acid and several inflammatory cytokinin's), and auto antibodies that can permanently damage and disables the joints 1, 2 . RA can strike at any age and more frequently occurs in persons between the ages of 30-50 years.

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“…However, clinicians tend to use them when in need of rapid symptomatic relief for their RA patients. Thus, the benefit-to-risk ratio of GCs is still uncertain, and their use in RA is still debatable [45].…”

Section: Glucocorticoid Therapy In Rheumatoid Arthritismentioning

confidence: 99%

Applications of Corticosteroid Therapy in Inflammatory Rheumatic Diseases

Mușetescu¹,

Criveanu²,

Bobircă³

et al. 2021

Corticosteroids - A Paradigmatic Drug Class

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Corticosteroids still remain the anchor drugs in therapy strategies for patients with inflammatory rheumatic diseases even though new drugs such as biologic or targeted synthetic molecules have emerged in the past years, being the most commonly prescribed medicines in the world due to their powerful immune-modulating properties. In this chapter, we aim to discuss the main characteristics of the glucocorticoids, their mechanism of action and effects on the immune system given the fact that they reduce the activation, proliferation, differentiation and survival of inflammatory cells such as macrophages and lymphocytes. Nevertheless, of great importance are the indications and tapering regimens, but also the adverse effects and various methods of monitoring the corticosteroid therapy.

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Glucocorticoids in rheumatoid arthritis: the picture is shaping up

Cited by 20 publications

References 17 publications

Optimising both disease control and glucocorticoid dosing is essential for bone protection in patients with rheumatic disease

Optimising both disease control and glucocorticoid dosing is essential for bone protection in patients with rheumatic disease

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Applications of Corticosteroid Therapy in Inflammatory Rheumatic Diseases

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