Glucocorticoids in rheumatoid arthritis: current status and future studies

被引:114
作者
Hua, Charlotte [1 ]
Buttgereit, Frank [2 ]
Combe, Bernard [3 ]
机构
[1] Montpellier Univ, Nimes Hosp, Rheumatol Dept, EA2415, Nimes, France
[2] Charite Univ Med Berlin CCM, Dept Rheumatol & Clin Immunol, Berlin, Germany
[3] Montpellier Univ, Montpellier Hosp, Rheumatol Dept, UMR 5535, Montpellier, France
关键词
MODIFYING ANTIRHEUMATIC DRUGS; LOW-DOSE PREDNISOLONE; LONG-TERM PREDNISONE; EULAR RECOMMENDATIONS; TREATMENT STRATEGIES; JOINT DESTRUCTION; DOUBLE-BLIND; OPEN-LABEL; THERAPY; METHOTREXATE;
D O I
10.1136/rmdopen-2017-000536
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Since their first use for treating rheumatoid arthritis (RA) in the late 1940s, glucocorticoids (GCs) have been representing a substantial part of the therapeutic arsenal for RA. However, even if GCs are still widely prescribed drugs, their toxicity is discussed controversially, so obtaining consensus on their use in RA is difficult. Hence, the most recent European League Against Rheumatism and American College of Rheumatology recommendations on early arthritis and RA management advocate the use of GCs as adjunct treatment to conventional synthetic disease-modifying antirheumatic drugs, at the lowest dose possible and for the shortest time possible. However, the recommendations remain relatively vague on dose regimens and routes of administration. Here, we describe literature data on which the current recommendations are based as well as data from recent trials published since the drafting of the guidelines. Moreover, we make proposals for daily practice and provide suggestions for studies that could help clarifying the place of GCs in RA management. Indeed, numerous items, including the benefit/risk ratio of low-dose and very low-dose GCs and optimal duration of GCs as bridging therapy, remain on the research agenda, and future studies are needed to guide the next recommendations for RA.
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页数:9
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