GLUCOCORTICOIDS AND RHEUMATOID ARTHRITIS

Abstract

Glucocorticoids (GCs) remain an important component of controlling the activity of rheumatoid arthritis (RA). If there is an opportunity to be treated with modern disease-modifying antirheumatic drugs, which compare favorably with the speed of achieving a therapeutic effect, short-term GCs administration can be useful and safe, although many specialists are restrained in this approach. International recommendations emphasize the indisputable benefit of GCs at the beginning of treatment, as well as during an exacerbation, but taking into account the minimum effective cumulative dose due to a wide range of potential side effects. Most medical practitioners prefer a dose of methylprednisolone 8 mg per day for a duration of 3 to 6 months, however, it is possible to vary the duration of the appointment and the dose depending on the needs of a particular clinical situation. Almost always, GCs ensure the success of treatment at the onset, as well as during episodes of exacerbation of RA, however, adherence to the safety principles and a careful assessment of the benefit-risk ratio for the patient is always necessary. Despite the reasonable optimism, one should not forget about the toxic effects of GCs, especially when used in moderate and high doses, especially over a long period of time. In addition, even low doses of GCs can have undesirable effects. The long-term safety of GCs may be related to the cumulative dose, and in addition to the daily dose, duration is also critical. GCs should be used in the minimum effective dose and for the shortest possible time. Most studies evaluated the efficacy of GCs as a “bridge therapy” in combination with different groups of traditional and modern basic drugs. Thus, existing studies are mainly focused on patients with RA onset, while data on RA with a long history is clearly insufficient. However, GC is also effective in this population for exacerbation control. If long-term, more than 6 months of GCs therapy is required, EULAR recommends a dose of 5 mg (as prednisolone) per day or less (if this is sufficient to control the disease). GCs monotherapy is not the optimal therapeutic approach, despite its low cost, and their potential in combination with methotrexate to reduce or delay the need for the use of modern effective biological and targeted basic agents.

Keywords

• glucocorticoids
• rheumatoid arthritis
• disease-modifying antirheumatic drugs
• “bridge therapy”.