https://orcid.org/0000-0002-9383-5722
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ABSTRACT
Introduction
Glucocorticoids are steroid hormones broadly used for the treatment of several inflammatory and autoimmune diseases among other numerous indications, including rheumatoid arthritis.
Areas covered
For the purposes of this article, the authors have performed an extensive review of the literature to present the latest studies on glucocorticoid use in rheumatoid arthritis. They also provide the reader with their expert perspectives on future developments.
Expert opinion
The authors do not anticipate that glucocorticoids with be replaced in the near future by newer drugs. As such, rheumatologists should be fully aware of the possible side-effects and educate appropriately their patients to recognize and report them. Newer formulations, such as the liposomal/nanoparticle-based treatments, will result in less pronounced adverse effects, but the input of clinical experience along with the current recommendations for the glucocorticoid use will benefit both clinicians and patients with rheumatoid arthritis.
Abbreviation
| 11β-HSD | = | 11β-hydroxysteroid dehydrogenase |
| ACCP | = | anti-cyclic citrullinated protein |
| ACR | = | American College of Rheumatology |
| ACTH | = | adrenocorticotropic hormone |
| AP-1 | = | Activated protein-1 |
| b | = | Biologic |
| CAPEA | = | Course And Prognosis of Early Arthritis |
| CAPRA | = | Circadian Administration of Prednisone in RA |
| COBRA | = | COmbinatietherapie Bij Reumatoide Artritis |
| CRH | = | corticotropin-releasing hormone |
| cs | = | conventional synthetic |
| DMARD | = | disease-modifying anti-rheumatic drug |
| ESPOIR | = | Etude et Suivi des Polyarthrites Indefférenciées Récentes |
| EULAR | = | European League Against Rheumatism |
| FDA | = | Food and Drug Administration |
| GC | = | Glucocorticoid |
| GITR | = | glucocorticoid-induced tumour necrosis factor receptor related protein |
| GR | = | Glucocorticoid receptor |
| GRE | = | Glucocorticoid responsive elements |
| HDAC2 | = | histone deacetylase 2 |
| HPA | = | hypothalamic-pituitary-adrenal |
| ICAM | = | Intercellular adhesion molecule |
| IFN | = | Interferon |
| IL | = | Interleukin |
| MRM | = | multiple reaction monitoring |
| MTX | = | methotrexate |
| NF | = | Nuclear factor |
| NICE | = | National Institute for Health and Care Excellence |
| RA | = | Rheumatoid arthritis |
| RF | = | rheumatoid factor |
| SEGRA | = | selective glucocorticoid receptor agonists |
| SEMIRA | = | steroid elimination in rheumatoid arthritis |
| SGRM | = | selective glucocorticoid receptor modulators |
| TNF | = | Tumour necrosis factor |
| ts | = | targeted-synthetic |
Highlights box
GCs are broadly used for the management of rheumatoid arthritis despite the appearance of novel drugs.
Side-effects are a great concern.
Lately, recommendations and treatment guidelines are trying to harmonize the use of GCs at the lowest possible dose and the shortest duration.
Low-dose GCs seem to bear less significant side-effects, but the benefit should always be weighed against risk.
Novel formulations are pending aiming at avoiding as much as possible the known side-effects of GCs.
Declaration of Interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.