RESEARCH - Steroids in the treatment of early and late RA

March 6, 2005

ls of the Rheumatic Diseases 2003;62:1033-1037

J W J Bijlsma1, M Boers2, K G Saag3 and D E Furst4

Glucocorticoids in the treatment of early and late RA

Excerpt:

Toxicity summary

An increasing number of clinical trials comparing GC users with non-users

inform us about the short and moderate term AEs in GC users. There are

credible data that even low dose GCs given for weeks to months can have

significant toxicity in numerous areas, including GI ulcerations and

bleeding when given together with NSAIDs, an increased incidence of

infections, an increased incidence of hyperglycaemia, a predisposition to

glaucoma, suppression of the HPA axis, abnormalities in recall and mental

functioning, and skin ecchymoses and thinning. Despite this increasing

knowledge, longer term data are badly needed to assess the impact of this

most commonly used treatment. Bone loss and cataracts are the complications

most well validated, whereas other long term AEs need further investigation.

Despite the fact that GCs improve functional status and reduce radiographic

erosions, it is imperative that we place their long term side effects into

the therapeutic equation in order to determine their appropriate place in

our treatment armamentarium.

CONCLUSION

There is thus clear evidence that GCs improve physical function and reduce

progression of joint damage in the treatment of RA. However, it cannot be

emphasised enough that the cautious use of GCs in patients with longstanding

RA should be weighed and balanced for the individual patient. A take home

message might be: " A little GC, like a glass of wine, may benefit many

(some -(sic)) people, whereas a high dose of GC, like a bottle of wine is

harmful to all " . In both cases long term intake might be harmful.

I'll tell you where to go!

Mayo Clinic in Rochester

s Hopkins Medicine

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