REVIEW - Current evidence for the management of RA with steroids

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Ann Rheum Dis. 2010 May 6. [Epub ahead of print]

Current evidence for the management of rheumatoid arthritis with

glucocorticoids: a systematic literature review informing the EULAR

recommendations for the management of rheumatoid arthritis.

Gorter SL, Bijlsma JW, Cutolo M, Gomez-Reino J, Kouloumas M, Smolen

JS, Landewé R.

1Maastricht University Hospital, Maastricht, The Netherlands.

Abstract

Glucocorticoids (GCs) rapidly reduce disease activity in early and

advanced rheumatoid arthritis (RA). This systematic review on behalf

of the task force on recommendations for the management of RA

addresses the efficacy of GCs in RA. A literature search was performed

in Medline, Embase, the Cochrane database, and the ACR/EULAR abstracts

2007 and 2008 on a set of questions relating to the use of GCs in RA.

Eleven publications (including three Cochrane reviews comprising 33

trials) that met the criteria for detailed assessment were found.

Robust evidence that GCs are effective as bridging therapy was

obtained. The addition of GCs, to either standard synthetic

disease-modifying antirheumatic drug (DMARD) monotherapy or

combinations of synthetic DMARDs, yields clinical benefits and

inhibition of radiographic progression that may extend over many

years. In early RA, the addition of low-dose GCs (<7.5 mg/day) to

DMARDs leads to a reduction in radiographic progression; in

longstanding RA, GCs (up to 15 mg/day) improve disease activity. There

is some evidence that appropriate timing of GC administration may

result in less morning stiffness. Only indirect information was found

on the best tapering strategy, supporting the general view that GCs

should be tapered slowly in order to avoid clinical relapses. GCs are

effective in relieving signs and symptoms and inhibiting radiographic

progression, either as monotherapy or in combination with synthetic

DMARD monotherapy or combination therapy.

PMID: 20448288

http://www.ncbi.nlm.nih.gov/pubmed/20448288

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