Views on glucocorticoid therapy in rheumatology: the age of convergence

被引:81
作者
Buttgereit, Frank [1 ]
机构
[1] Charite, Dept Rheumatol & Clin Immunol, Berlin, Germany
关键词
MODIFYING ANTIRHEUMATIC DRUGS; GIANT-CELL ARTERITIS; LOW-DOSE PREDNISONE; EULAR RECOMMENDATIONS; POLYMYALGIA-RHEUMATICA; MORNING STIFFNESS; ARTHRITIS; MANAGEMENT; EFFICACY; COLLEGE;
D O I
10.1038/s41584-020-0370-z
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Glucocorticoids have been used to treat patients with rheumatic diseases for more than 70 years, but have been controversial owing to their safety record. Are we now entering an age when opinions about their use in rheumatology clinics are converging? After decades of sometimes fierce debate about the advantages and disadvantages of glucocorticoids, an age of convergence has been reached. Current recommendations for the management of diseases such as rheumatoid arthritis (RA), polymyalgia rheumatica and large vessel vasculitis reflect the current consensus that as much glucocorticoid as necessary, but as little as possible, should be used. Over the past few years, a range of glucocorticoid-sparing strategies have been developed, as have tools to improve the management of this therapy. A comprehensive view of glucocorticoid-induced osteoporosis has also emerged that recognizes that bone fragility is not solely determined by the dose and duration of glucocorticoid treatment. Nevertheless, open questions remain around whether long-term use of very low doses of glucocorticoids is a realistic option for patients with RA and whether the search for innovative glucocorticoids or glucocorticoid receptor ligands with improved benefit-to-risk ratios will ultimately be successful.
引用
收藏
页码:239 / 246
页数:8
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