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Review
Glucocorticoids in rheumatoid arthritis: current status and future studies
  1. Charlotte Hua1,
  2. Frank Buttgereit2 and
  3. Bernard Combe3
  1. 1 Rheumatology Department, Nîmes Hospital, EA2415, Montpellier University, Nîmes, France
  2. 2 Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin (CCM), Berlin, Germany
  3. 3 Rheumatology Department, Montpellier hospital, UMR 5535, Montpellier University, Montpellier, France
  1. Correspondence to Dr Charlotte Hua; hua.charlotte{at}gmail.com

Abstract

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.

  • rheumatoid Arthritis
  • corticosteroids
  • treatment
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors Conception or design of the work: CH, BC. Drafting the article: CH, BC. Critical revision of the article: BC, FB. Final approval of the version to be published: CH, FB, BC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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