Abstract
Glucocorticoids are drugs used in various medical areas, but well known for the myriad of side effects which are still a concern for the medical world. Latest recommendations on this matter aim at improving their management and implementing adequate prevention strategies. This aspect would change patient’s perspective on this treatment, reducing the fear and uncertainty associated with glucocorticoids. Objective. Our study focuses on analysing the level of information that patients hold about glucocorticoids side effects and if the available prevention strategies are known and applied in clinical practice. Material and methods. Study included 85 patients with rheumatic pathology and glucocorticoid therapy for at least 3 months. Study design was prospective observational and consecutive hospitalized patients were recruited, receiving and compiling a specific questionnaire. Results. 85 patients (84.7% women, mean age 54.42 ± 16.54 years) mostly under corticotherapy due to rheumatoid arthritis (44.7%) and systemic lupus erythematosus (23.5%) were recruited. Patients with higher education had the tendency to discontinue treatment (r=0.289, p=0.007). Moreover, reading prospectus has a great influence on treatment compliance (treatment risks significantly correlated with disease duration and glucocorticoid therapy duration (r=0.232; p < 0.032, r=0.252; p <0.024 respectively). Awareness about the risk of osteoporosis correlates with reading the prospectus (r= 0.396; p <0.0001), glucocorticoid treatment duration (r=0.209; p <0.032) and the use of vitamin D supplements (r=0,315; p <0.003). Regarding glucocorticoid administration timetable, we identified two groups – early morning and late evening (44.7% vs. 55.3%), showing a non-uniform treatment schedule. Conclusions. Our study shows an inadequate level of information regarding patient’s awareness on glucocorticoid treatment. Although excellent prevention strategies have been elaborated, there is a need of optimizing their accessibility to our patients.
Highlights
The use of glucocorticoids (GC) represents a vital element for rheumatic pathology management
Regarding rheumatic illnesses encountered in the study group, there were 38/85 (44.7%) patients with rheumatoid arthritis, 20/85 (23.5%) systemic lupus erythematosus, and the remaining 27/85 (31.8%) had other rheumatic conditions as will be detailed in tables below (Table 1 and Table 2)
Our evaluation showed that 21/85 (24.7%) patients have changed on own initiative their daily treatment doses and 33/85 (38.8%) patients have abruptly discontinued glucocorticoid therapy without a doctor’s indication
Summary
The use of glucocorticoids (GC) represents a vital element for rheumatic pathology management. Glucocorticoids can solve critical medical situations by the use of high doses on short duration but are more frequently used as low/medium doses and long-term therapy [1]. Side effects such as iatrogenic Cushing syndrome, electrolyte disturbances, osteoporosis and vertebral fractures, glucose intolerance, cataracts, glaucoma, myopathy, psychiatric and digestive disorders seem to be proportional to treatment dosage and duration [2]. All recommendations were based on complex analysis of existing studies and on evidence derived from clinical practice and taking into account patients opinion and preferences. This shows, once again, the need for patient involvement in treatment optimization and that, in order to diminish negative treatment implications, ROMANIAN JOURNAL OF RHEUMATOLOGY – VOLUME XXIV, NO. 4, 2015
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