Now in the 75th year since the first presentation on the clinical use of glucocorticoids, what consensus has been reached in sparing their use to avoid their many potential adverse effects?
on the"sensational" effects of cortisone in the treatment of rheumatoid arthritis , glucocorticoids are still highly relevant and widely used in the management of RA and other immune-mediated inflammatory diseases.
Rheumatology societies generally agree that clinicians should try to minimize GC use or eventually discontinue the therapy. EULAR also recommends GC bridging when initiating or changing conventional synthetic DMARDs. This effectively dismisses the use of GCs when using biologic DMARDs or targeted synthetic DMARDs. As a bridging therapy, EULAR recommends either a single parenteral dose of GC or a predefined tapering or discontinuation scheme within 3 months, when starting an oral GC.
One limitation of the SEMIRA trial was that it studied the effect of tocilizumab as a GC-sparing agent, and it didn't consider using a tumor necrosis factor or Janus kinase inhibitor, which might have a more potent effect on pain and GC dose reduction, Adami said.
Low-dose GCs are lesser toxic than high-dose GCs, noted Joan Merrill, MD, a professor with the Arthritis and Clinical Immunology Research Program at The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma."There may be less weight gain, less chance of acne, and less risk for all the slower, more organ-threatening side effects."Merrill, who cares for patients with lupus, said physicians can keep lupus in check for years, using constant, low-dose GCs.
The big question is: Why don't these observational studies show an increased risk for adverse events with biologic drugs that are given to more severe patients?"That confirms the hypothesis that confounding by indication for GCs is minimal, and most of the risk is driven by GCs," he said.
All patients should receive an appropriate treat-to-target strategy with csDMARDs and biologics if needed, he added.
RA - Rheumatoid Arthritis Rheumatoid Arthritis (RA) Corticosteroid Sparing Immunosuppression Corticosteroid Taper Corticosteroid Withdrawal Corticosteroid-Induced Myopathy Corticosteroid Jak/Stat Jak-Stat Signaling Pathway Jak-Stat Cytokine Receptors Healthcare And Medical Technology Health And Medical Tech Health And Med Tech Health And Medical Technology
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