An updated review of glucocorticoid-related adverse events in patients with rheumatoid arthritis

ABSTRACT

Introduction: Glucocorticoids represent a cornerstone in the treatment of rheumatoid arthritis. Their effect as a disease-modifying treatment in rheumatoid arthritis is well established. Despite this, the risk of adverse events of glucocorticoids, especially in high doses and over a long time, is constantly highlighted. Data on the prevalence and impact of glucocorticoid-related adverse effects in rheumatoid arthritis is needed, therefore, to be regularly revisited.

Areas covered: In this review, our primary aim was to provide an update of evidence from randomized controlled trials and observational cohort studies on the safety of glucocorticoid treatment in rheumatoid arthritis. Our secondary aim was to provide a critical overview of the concerns raised with both study designs – randomized clinical trials versus nonrandomized observational studies – regarding the assessment of the safety of glucocorticoids in rheumatoid arthritis.

Expert opinion: In the meantime, adherence to recommendations and consensus on standardized methodologies for monitoring and reporting adverse events is essential to improve our knowledge and competence in the best management of glucocorticoids.

KEYWORDS:

• Adverse events
• glucocorticoids
• rheumatoid arthritis
• risk
• safety
• toxicity

Article highlights

• Evidence to support clear conclusions regarding safety remains limited, both in quantity and quality.

• Observational data are often negatively affected by bias by indication and other methodological issues that hinder interpretation; such strong bias cannot be overcome by statistical techniques.

• More attention should be given to monitoring and reporting GC-AEs in clinical trials.

• Large prospective trials dedicated to the safety of low-dose GC are dearly needed.

• Adherence to guidelines/recommendations may contribute to reduce and better understand GC-related AEs and optimize their use for the benefit of patients.

This box summarizes key points contained in the article.

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.

Additional information

Funding

This paper was not funded.