Glucocorticoids in Management of Adult Rheumatoid Arthritis-Current Prescribing Practices and Perceptions of Physicians in India: GLUMAR Survey

Abstract

Background: Several questions about use of glucocorticoids in rheumatoid arthritis are unanswered. Objective: Understanding perspectives of physicians regarding use of glucocorticoids in rheumatoid arthritis management. Material and methods: Rheumatologists were interviewed to understand their perspectives and experiences on use of glucocorticoids in rheumatoid arthritis treatment. Results: Of the enrolled 150 physicians, 74% reported using glucocorticoids to always in the initial treatment whereas 143 (95.4%) reported it using to always in acute exacerbations; 40% sometimes as an adjuvant to disease modifying antirheumatic drugs therapy. Oral low dose prednisolone or equivalent (<15 mg/day) is used by 101 (67.3%) physicians in up to 50% patients. Intra-articular low dose and high dose steroid injections are used by 98 (65.3%) and 55 (36.7%) physicians in up to 50% patients respectively. All physicians used oral methylprednisolone whereas prednisone, triamcinolone and hydrocortisone was used by 98.7%, 98.7% and 97.3% physicians respectively. For short term course, 92 (61.3%) physicians prescribe 5-10 mg/day of prednisone or equivalent. Clinical improvement is excellent and very good according to 36.7% and 44.0% physicians. Functional improvement is excellent and very good according to 26.7% and 38.7% respectively. Weight gain, puffiness of face, fluid retention, osteoporosis, hyperglycemia, hypertension, nausea, weakness, infection, cataract, sleep disturbances, psychosis and glaucoma were the adverse events reported by 121 (80.7%), 115 (76.7%), 100 (66.7%), 87 (58%), 81 (54%), 56 (37.3%), 51 (34.4%),46 (30.7%),44 (29.3%), 36 (24%),29 (19.3%), 23 (15.3%) and 19 (12.7%) physicians in past six months respectively. Conclusion: Steroids usage for the treatment of rheumatoid arthritis in adult patients is very common among rheumatologists in India. According to this physicians´s opinion based survey, overall tolerability, safety and patient compliance with oral GCs is fair to excellent. Short term use is not a major concern from safety point of view.