Tapering glucocorticoids in rheumatoid arthritis

Abstract

Glucocorticoids are a cornerstone of care for patients with rheumatoid arthritis. Since the 1950s, glucocorticoids have been used to reduce inflammation and symptoms of arthritis, improve physical function, and reduce disability. These drugs are widely available, inexpensive, and typically combined with disease-modifying antirheumatic drugs to induce remission in rheumatoid arthritis. However, the administration of glucocorticoids is not without risk. Long-term use of glucocorticoids is associated with increased mortality, 1 Chester Wasko M Dasgupta A Ilse Sears G Fries JF Ward MM Prednisone use and risk of mortality in patients with rheumatoid arthritis: moderation by use of disease-modifying antirheumatic drugs. Arthritis Care Res. 2016; 68: 706-710 Crossref PubMed Scopus (32) Google Scholar cardiovascular events, 2 Roubille C Richer V Starnino T et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriaznn. Rheum Dis. 2015; 74: 480-489 Crossref PubMed Scopus (512) Google Scholar and bone fractures. 3 Tong JJ Xu SQ Zong HX Pan MJ Teng YZ Xu JH Prevalence and risk factors associated with vertebral osteoporotic fractures in patients with rheumatoid arthritis. Clin Rheumatol. 2020; 39: 357-364 Crossref PubMed Scopus (20) Google Scholar For this reason, rheumatoid arthritis management guidelines advocate using low-dose glucocorticoids (≤10 mg daily of a prednisone equivalent) during the initiation of a new disease-modifying antirheumatic drug and for a relatively short duration (<3 months) when treating a flare. 4 Singh JA Saag KG Bridges SL et al. 2015 American college of rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2016; 68: 1-26 Crossref PubMed Scopus (2102) Google Scholar , 5 Smolen JS Landewé R Bijlsma J et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017; 76: 960-977 Crossref PubMed Scopus (1714) Google Scholar Continuing versus tapering glucocorticoids after achievement of low disease activity or remission in rheumatoid arthritis (SEMIRA): a double-blind, multicentre, randomised controlled trialIn patients who achieved low disease activity with tocilizumab and at least 24 weeks of glucocorticoid treatment, continuing glucocorticoids at 5 mg per day for 24 weeks provided safe and better disease control than tapering glucocorticoids, although two-thirds of patients were able to safely taper their glucocorticoid dose. Full-Text PDF