EDITORIAL - Steroids in the management of early and established rheumatoid disease

[Guest guest]

Rheumatology Advance Access originally published online on July 31, 2006

Rheumatology 2006 45(9):1058-1061; doi:10.1093/rheumatology/kel230

© The Author 2006. Published by Oxford University Press on behalf of the

British Society for Rheumatology. All rights reserved. For Permissions,

please email: journals.permissions@...

--------------------------------------------------------------------------

EDITORIAL

Corticosteroids in the management of early and established rheumatoid

disease

E. on1, and H. A. Capell2

1Department of Rheumatology, Southern General Hospital and 2Centre for

Rheumatic Diseases, Glasgow Royal Infirmary, Scotland, UK

Excerpt:

SUMMARY

The use of corticosteroids in RA is clearly something of a clinical

balancing act, the key to which would seem to be judicious timing. Early

initiation of DMARD therapy in new onset RA, with escalation as required to

achieve disease control, is the essence of current good practice.

Corticosteroids used early and for short periods, either orally or

parentally, are an effective adjunctive measure. The caveat being that

detailed information about their side-effect profile in this setting is

lacking. In established RA, however, the evidence suggests that

corticosteroids should be reserved for short-term use during flares of

disease activity or as bridge therapy until the efficacy of a DMARD is

established. Longer use cannot be justified as the clinical and radiological

benefits are relatively small and adverse events not inconsequential.

Despite some continuing uncertainties and reservations, the results of

recent RCTs have undoubtedly refined our use of, and subtly altered the

position of, corticosteroids in the management of both early and established

RA. They remain, therefore, one of our most powerful and useful therapeutic

interventions and it is our responsibility to use them wisely.

For the full editorial, please see:

http://rheumatology.oxfordjournals.org/cgi/content/full/45/9/1058

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org