Adverse events of glucocorticoids during treatment of rheumatoid arthritis: lessons from cohort and registry studies

Glucocorticoids have now been used for > 65 years in the treatment of RA. There is good evidence for their disease-modifying effect, especially in early RA. When used in a dosage of 7.5-10 mg/day, most adverse effects can be handled quite well, although monitoring for and awareness of infections are important. Adverse events may have been overreported, due to bias by indication, but pose an important drawback in the use of these very effective anti-inflammatory and immune-modulatory drugs. Daily dosages > 7.5-10mg and use for a prolonged period (years) of time are associated with a dose-dependent increased mortality. Still, the benefit: risk ratio for low-dosage glucocorticoid in patients with RA is acceptable and in many ways is comparable with other synthetic and biologic DMARDs.