Current evidence for the management of rheumatoid arthritis with glucocorticoids: A systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis

Division of Internal Medicine, Subdivision of Rheumatology, Maastricht University Hospital, P Debeyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Annals of the rheumatic diseases (Impact Factor: 10.38). 06/2010; 69(6):1010-4. DOI: 10.1136/ard.2009.127332
Source: PubMed


Glucocorticoids (GCs) rapidly reduce disease activity in early and advanced rheumatoid arthritis (RA). This systematic review on behalf of the task force on recommendations for the management of RA addresses the efficacy of GCs in RA. A literature search was performed in Medline, Embase, the Cochrane database, and the ACR/EULAR abstracts 2007 and 2008 on a set of questions relating to the use of GCs in RA. Eleven publications (including three Cochrane reviews comprising 33 trials) that met the criteria for detailed assessment were found. Robust evidence that GCs are effective as bridging therapy was obtained. The addition of GCs, to either standard synthetic disease-modifying antirheumatic drug (DMARD) monotherapy or combinations of synthetic DMARDs, yields clinical benefits and inhibition of radiographic progression that may extend over many years. In early RA, the addition of low-dose GCs (<7.5 mg/day) to DMARDs leads to a reduction in radiographic progression; in longstanding RA, GCs (up to 15 mg/day) improve disease activity. There is some evidence that appropriate timing of GC administration may result in less morning stiffness. Only indirect information was found on the best tapering strategy, supporting the general view that GCs should be tapered slowly in order to avoid clinical relapses. GCs are effective in relieving signs and symptoms and inhibiting radiographic progression, either as monotherapy or in combination with synthetic DMARD monotherapy or combination therapy.

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    • "Thus, the treatment of LORA patients with corticosteroids did not reduce radiological progression, despite the positive effects of these drugs on inflammatory activity. Treatment with low doses of prednisolone as a monotherapy, or in combination with DMARDs, has previously been reported to have positive effects with respect to the remission rate and inhibition of radiographic progression [46-48]. However, contrasting results were reported by Paulus et al., who found that monotherapy with low-dose corticosteroids did not prevent radiological progression [49]. "
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