Use Of Low-dose Corticosteroids Research Articles

Role of Low Dose Intravenous Methylprednisolone in Pulmonary Hemorrhage Associated with Severe Leptospirosis

Leptospirosis, an emerging zoonosis endemic in Malaysia, presents with diverse clinical manifestations, ranging from mild to potentially fatal illness. Pulmonary involvement in leptospirosis, particularly pulmonary hemorrhage, poses a significant risk of mortality, prompting exploration of various treatment strategies. While high-dose corticosteroid therapy has demonstrated efficacy in some studies, data on the use of low-dose corticosteroids in pulmonary leptospirosis remain scarce. Here, we report a case of successful treatment with low-dose methylprednisolone in a patient diagnosed with Weil’s disease and pulmonary hemorrhage. The patient, initially presenting with fever, vomiting and hemoptysis, rapidly deteriorated, necessitating intubation due to respiratory distress. Prompt initiation of low-dose methylprednisolone alongside antibiotic therapy resulted in clinical improvement, resolution of pulmonary hemorrhage, and normalization of laboratory parameters. This case highlights the potential efficacy of low-dose corticosteroid therapy in managing severe pulmonary involvement in leptospirosis, offering insights into alternative treatment modalities for this challenging condition. Further studies are warranted to elucidate the optimal dosing and timing of corticosteroid therapy in leptospirosis-associated pulmonary complications.

Disease activity and disease-related factors are drivers of patient global assessment in rheumatoid arthritis: a real-life cross-sectional study

Despite that the Patient Global Assessment (PGA) is widely used for measuring Rheumatoid Arthritis (RA) disease activity to define the remission state of the disease, the primary contributors influencing patients’ ratings are still debated. This study aims to determine which clinical, sociodemographic and lifestyle-related contextual factors might be key drivers of PGA in RA. This single-center cross-sectional study recruited 393 consecutive adult RA patients. Median age 60 years, females 306 (77.9%). Data related to disease activity were assessed by using Simplified Disease Activity Index (SDAI), severity by Health Assessment Questionnaire (HAQ), and impact by RA Impact of Disease (RAID). Sociodemographic/lifestyle features were collected. Disease remission was calculated using Boolean-based criteria 1.0 and 2.0. Quantile regression models were used for univariate and multivariate analysis. The remission rate progressively increased from 15% by using SDAI with a Boolean 1.0-based definition to 43.5% using a Boolean 2.0-based remission. Among factors related to disease activity, the use of low-dose corticosteroids, the RAID items pain and sleep difficulties were predictive for worse PGA scores (p = 0.01). Among factors related to disease severity HAQ score and RAID total were independent factors associated with higher median PGA (p = 0.02 and p < 0.001). RAID’s physical well-being was related to PGA scores (p = 0.01). An increasing trend in PGA was observed in longstanding diseases (> 15 years). Our results confirmed that there is no unambiguous interpretation of the PGA score. It is a measure related to some disease activity parameters, but it is also influenced by contextual factors related to disease severity and impact. These data highlighted that PGA should have a broad interpretation, thus supporting the proposal of a dual targets (biological and impact) approach to obtain a more accurate estimate of disease activity.

Physiologic effects of stress dose corticosteroids in in-hospital cardiac arrest (CORTICA): A randomized clinical trial

AimPostresuscitation hemodynamics are associated with hospital mortality/functional outcome. We sought to determine whether low-dose steroids started during and continued after cardiopulmonary resuscitation (CPR) affect postresuscitation hemodynamics and other physiological variables in vasopressor-requiring, in-hospital cardiac arrest. MethodsWe conducted a two-center, randomized, double-blind trial of patients with adrenaline (epinephrine)-requiring cardiac arrest. Patients were randomized to receive either methylprednisolone 40 mg (steroids group) or normal saline-placebo (control group) during the first CPR cycle post-enrollment. Postresuscitation shock was treated with hydrocortisone 240 mg daily for 7 days maximum and gradual taper (steroids group), or saline-placebo (control group). Primary outcomes were arterial pressure and central-venous oxygen saturation (ScvO2) within 72 hours post-ROSC. ResultsEighty nine of 98 controls and 80 of 86 steroids group patients with ROSC were treated as randomized. Primary outcome data were collected from 100 patients with ROSC (control, n = 54; steroids, n = 46). In intention-to-treat mixed-model analyses, there was no significant effect of group on arterial pressure, marginal mean (95% confidence interval) for mean arterial pressure, steroids vs. control: 74 (68–80) vs. 72 (66–79) mmHg] and ScvO2 [71 (68–75)% vs. 69 (65–73)%], cardiac index [2.8 (2.5–3.1) vs. 2.9 (2.5–3.2) L/min/m2], and serum cytokine concentrations [e.g. interleukin-6, 89.1 (42.8–133.9) vs. 75.7 (52.1–152.3) pg/mL] determined within 72 hours post-ROSC (P = 0.12–0.86). There was no between-group difference in body temperature, echocardiographic variables, prefrontal blood flow index/cerebral autoregulation, organ failure-free days, and hazard for poor in-hospital/functional outcome, and adverse events (P = 0.08–>0.99). ConclusionsOur results do not support the use of low-dose corticosteroids in in-hospital cardiac arrest.Trial Registration:ClinicalTrials.gov number: NCT02790788 (https://www.clinicaltrials.gov).

Insights Into Thiamine Supplementation in Patients With Septic Shock.

Septic shock is associated with unacceptably high mortality rates, mainly in developing countries. New adjunctive therapies have been explored to reduce global mortality related to sepsis. Considering that metabolic changes, mitochondrial dysfunction and increased oxidative stress are specific disorders within the path of septic shock, several micronutrients that could act in cellular homeostasis have been studied in recent decades. Thiamine, also known as vitamin B1, plays critical roles in several biological processes, including the metabolism of glucose, synthesis of nucleic acids and reduction of oxidative stress. Thiamine deficiency could affect up to 70% of critically ill patients, and thiamine supplementation appears to increase lactate clearance and decrease the vasopressor dose. However, there is no evident improvement in the survival of septic patients. Other micronutrients such as vitamin C and D, selenium and zinc have been tested in the same context but have not been shown to improve the outcomes of these patients. Some problems related to the neutrality of these clinical trials are the study design, doses, route, timing, length of intervention and the choice of endpoints. Recently, the concept that multi-micronutrient administration may be better than single-micronutrient administration has gained strength. In general, clinical trials consider the administration of a single micronutrient as a drug. However, the antioxidant defense is a complex system of endogenous agents in which micronutrients act as cofactors, and the physiological interactions between micronutrients are little discussed. In this context, the association of thiamine, vitamin C and corticoids was tested as an adjunctive therapy in septic shock resulting in a significant decrease in mortality. However, after these initial results, no other study conducted with this combination could reproduce those benefits. In addition, the use of low-dose corticosteroids is recommended in patients with septic shock who do not respond to vasopressors, which can affect the action of thiamine. Therefore, given the excellent safety profile, good biologic rationale and promising clinical studies, this review aims to discuss the mechanisms behind and the evidence for single or combined thiamine supplementation improving the prognosis of patients with septic shock.

Low disease activity state in juvenile-onset systemic lupus erythematosus.

To determine the rate of achieving The Lupus Low Disease Activity State (LLDAS) in children with systemic lupus erythematosus (SLE) for tracing pertinent treatment modalities. A total of 122 juvenile-onset SLE (jSLE) patients from six pediatric rheumatology centers in Turkey were enrolled in the study. LLDAS-50 was defined as encountering LLDAS for at least 50% of the observation time. According to the achievement of LLDAS-50, clinical features, immunological profiles, and treatments of patients with jSLE have been revealed. LLDAS of any duration was achieved by 82% of the cohort. Although only 10.8% of the patients achieved remission, 68.9% reached LLDAS-50. A significant difference was found between patients who reached LLDAS-50 and those who did not, in terms of the time to reach low-dose corticosteroid treatment (p = 0.002), the presence of subacute cutaneous findings (p = 0.007), and the presence of proteinuria (p = 0.002). Both of the groups were under similar treatment approaches. However, the number of patients being treated with corticosteroids at the last visit was found to be significantly higher in patients who achieved LLDAS-50 (p<0.001). Targeting LLDAS in jSLE, even with long-term, low-dose corticosteroid use, seems to be an achievable goal in clinical practice.

Efficacy and safety of low-dose corticosteroids for acute respiratory distress syndrome: A systematic review and meta-analysis.

There are conflicting results regarding whether corticosteroids have better efficacy than placebo in acute respiratory distress syndrome (ARDS) patients. Therefore, we aim to further evaluate the efficacy and safety of corticosteroids in adult ARDS patients. The databases, including Medline, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, were searched from their inception to May 2, 2020. Randomized controlled trials (RCTs) and observational cohort studies were selected to assess the use of corticosteroids in adult ARDS patients. The quality of the results was judged by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The inverse-variance method with random or fixed effects modeling was used to compute pooled odds ratio (OR), standardized mean difference (SMD), and their 95% confidence interval (CI). Eight eligible RCTs and six cohort studies were included. The use of corticosteroids was associated with reduced mortality (OR 0.57, 95% CI 0.43-0.76, I2=35.1%, P=0.148) in ARDS patients, and the result was confirmed in the included cohort studies (OR 0.51, 95% CI 0.27-0.95, I2=66.7%, P=0.010). The subgroup analysis stratified by the initiation time and duration of corticosteroid use showed that early ARDS and prolonged corticosteroid use had significant survival benefits in the RCTs. The low-dose corticosteroid use was also associated with significantly more ventilator-free days and a reduced rate of new infections in ARDS patients. The low-dose corticosteroid therapy may be safe and reduce mortality, especially in patients with prolonged treatment and early ARDS.

Comparative Study between the Uses of High Dose Corticosteroid Therapy for Short Duration Versus Low Dose Corticosteroid for Long Duration in Severe Lung Contusion with ARDS

Introduction: Corticosteroids are used in ARDS to prevent lung fibrosis. The best dose, duration and regimen are still the points of debate among physicians. Aim of the Work: The aim of this study is to make a comparison between two corticosteroid regimens, i.e. short-duration high dose versus long- duration low dose corticosteroid use in ARDS due to lung contusion with VAP for lowering both morbidity and mortality rates and early weaning from ventilator. Patients and Methods: Patients who had &gt;3 on Murray score and &gt;6 on CPIS were allocated randomly in two groups of 120 patients each. Group A received 30 mg/kg methyl-prednisolone slowly intravenously in 250 ml normal saline every 8 hours for only 48 hours, while group B received 1 mg/kg/day methyl-prednisolone divided into three doses given every 8 hours for two weeks. The study lasted for 16 days; morbidity was considered if no improvement was observed in any or all clinical parameters of both Murray and CPIS scores and if there was failure in removing patients from the ventilator within the studied period. Results: Significant improvement was observed in patients of group B compared to group A with regard to APACH II &lt;10 score, arterial oxygen saturation&gt;95, hypoxic index &gt;300, lung infiltrate in chest X-ray, lung compliance, response of the lung to recruitment maneuver, the return of core temperature to normal, normal tracheal secretion, the return of leucocytic count to normal, negative qualitative sputum culture and a significantly higher number of patients were removed from the ventilator of group B compared to group A. However, mortality rate was not significant between the two groups. Conclusion: Low dose corticosteroid if used for a long duration significantly lowers morbidity and accelerates recovery, and in turn, accelerates weaning from ventilator compared to high dose corticosteroid used for a short duration. While the difference between the two regimens was not significant with regard to the mortality rate, still further studies are needed to emphasize a fixed corticosteroid dose and regimen in ARDS due to lung contusion.

COVID-19 in Liver Transplant Recipients: An Initial Experience From the US Epicenter

COVID-19 in Liver Transplant Recipients: An Initial Experience From the US Epicenter

Safety and Tolerability of Two Different Formulations of Mycophenolate (Mycophenolate Mofetil and Mycophenolate Sodium) among Patient with Connective Tissue Disease Associated Interstitial Lung Disease (CTD-ILD) in a Tertiary Care Hospital

Background: One of the leading cause of mortality in various connective tissue diseases(CTD) like systemicsclerosis(SSc)is Interstitial lung disease(ILD). The various CTD which may present as ILD include systemicsclerosis (SSc), rheumatoid arthritis(RA),dermatomyositis (DM), primary Sjogren’s syndrome(pSS), mixtedconnective tissue disease(MCTD) and systemic lupus erythematosus (SLE).Objective: To compare the safety and tolerability of two salts of mycophenolate,i.e. mycophenolate mofetiland mycophenolate sodium in our patients with CTD-ILD.Patients and Method: Ourstudy was retrospective observational study; involving 70 patients diagnosedwith CTD-ILD and was treated with two formulations of Mycophenolate (Mofetil and Sodium) minimumfor six months with at least one follow-up during the period of May 2013 to April 2017 at tertiary carehospital from India. Fifty-six patients received MPS and fourteen patients received MMF. The details ofpatients obtained from case records were recorded in a proforma. Statistical analysis was performed usingGraph pad for frequency, mean and percentages.Results: In our study,most of the patients receivedMycophenolate sodium (n=56) with the BD dose regimenof 720 mg (n=36), 540 mg (n=18) and 180 mg (n=2). Patients treated with MMF 1000 mg (n=12) and 750mg (n=2) as BD dose regimen.The adverse events reported in this study were GI (diarrhoea), herpes zosterinfection, cytopenia, malignancies or any other infections. The incidence of diarrhea is most commonlyobserved in this study population. Out of 26 reported cases, 14 patients had an episode of diarrhea at leastonce and 12 patients had diarrhea attack twice the preceding year.Conclusions: Both formulations of Mycophenolate were tolerated well, and have low-dose corticosteroiduse with no discontinuation of therapy.

Effectiveness and Outcome of Methylprednisolone versus Hydrocortisone in Treatment of Acute Respiratory Distress Syndrome(ARDS)

Abstract Introduction Acute respiratory distress syndrome (ARDS) is the clinical manifestation of severe acute lung injury. It is characterized by dyspnea, profound hypoxemia, diffuse bilateral infiltrates secondary to non-cardiogenic pulmonary edema on chest radiography, and decreased lung compliance and systemic inflammations are the pathophysiologic hallmarks of this syndrome and the use of low-dose corticosteroids was associated with improved mortality and morbidity outcomes without increased adverse reactions. Aim The aim of this study is to compare the outcome and effectiveness of hydrocortisone to methylprednisolone in treatment of acute respiratory distress syndrome in critically ill adult patients. Patients The current study was performed as a randomized prospective observational study on critically ill patients at age between 18-85 years. Methods Critically ill patients diagnosis with ARDS were managed with standard treatment in addition to methylprednisolone 1mg/kg as loading dose followed by an infusion of 1 mg/kg/d for one week and then gradual tapering over two weeks as following (0.5 mg/kg/d in the second week and 0.25 mg/kg/d in the third week) or hydrocortisone 50mg given every six hours for one week. Results Mean age of included patients was 65.20 years with mean BMI 28.14 kg/m2, in our result the PaO2/FIO2 ratio revealed significant statistically increase in methylprednisolone-treated patients compared to hydrocortisone -treated patients (160.49±54.75, 138.55±60.99, P value 0.029), Regarding the inflammatory marker the results of the plasma level of C-reactive protein and d-dimer showed significant difference between both group, the result of SOFA score showed no significant different from day 1 to day 3 (8.25±3.11, 8.29±2.29 P value 0.980). But with the beginning of the fifth day was observed significant change in the results, methylprednisolone-treated patients compared to hydrocortisone -treated patients (8.28±3.84, 9.8±4.23, P value 0.036), Regarding to ICU length of stay and decrease duration of mechanical ventilation, the results of our study didn’t show significant different among both groups. The two groups showed a decrease in the time spended on the mechanical ventilation and the stay in the ICU before day7. According to the number of patient discharge from ICU at day 7 and the number of extubated patient at day 7, the results of our study didn’t show significant different among both groups. Conclusion Despite the both applied drug doses show improvement regarding the finial total outcome. However, Methylprednisolone showed superior benefit compare to Hydrocortisone in improvement of PaO2/FiO2 ratio, suppress systemic inflammation (CRP and D- dimer), increase extubated patient before day 7, increase number of patient discharge from ICU before day 7, reduction of SOFA score and hospital morality rate. Recommendations The study recommends to use of low dose methylprednisolone superior to hydrocortisone in treatment of ARDS. But, still more researches are need.

Effect of different doses and time-courses of corticosteroid treatment in patients with acute respiratory distress syndrome: A meta-analysis.

While previous trials have indicated that the use of corticosteroids for patients with acute respiratory distress syndrome (ARDS) is effective, the dosage and time-course for the use of corticosteroids remain a subject of controversy. The present study aimed to address and resolve these problems. PubMed, Embase and the Cochrane Library databases were searched from inception to March 2017 for randomized controlled trials (RCTs), which included patients with ARDS using corticosteroids. Related data were extracted independently by two investigators. The Mantel-Haenszel method was used with random-effects modeling to calculate the pooled odds ratio (OR) and 95% confidence interval (CI) for the mortality of patients with ARDS, and the risk of new infection arising from the use of glucocorticoids. The inverse variance method was used to calculate the mean difference (MD) and 95% CI for the duration of mechanical-free ventilation and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FIO2 ratio). The use of low-dose corticosteroids significantly reduced the mortality rate of patients with ARDS (OR: 0.43; 95% CI: 0.24–0.79; P=0.006) while the use of high-dose corticosteroids provided no significant benefit to reducing the mortality rate (OR: 1.33; 95% CI: 0.86–2.04; P=0.20). The present study identified that glucocorticoids reduced the mortality rate of patients during the early stages of ARDS (OR: 0.61; 95% CI: 0.43–0.86; P=0.005). Glucocorticoids significantly reduced the duration of mechanical ventilation (MD: 3.08; 95% CI: 1.49–4.68; P<0.05) and significantly improved the PaO2/FiO2 ratio (MD: 66.39; 95% CI: 57.79–74.98; P<0.05). The use of corticosteroids did not significantly increase the rate of infectious complications (OR: 0.60; 95% CI: 0.32–1.12; P>0.05). The use of low-dose corticosteroids may significantly reduce the mortality rate, particularly in the early stages of ARD, shorten the duration of mechanical ventilation and improve the PaO2/FiO2 ratio without increasing the risk of a new infection.

Incidence of fatigue and low-dose corticosteroid use in prostate cancer patients receiving systemic treatment: a meta-analysis of randomized controlled trials.

Cancer-related fatigue (CRF) is a complex condition that is reported in > 50% of cancer patients. In men with castration-resistant prostate cancer (CRPC), CRF was reported in 12-21% of patients. Approved systemic therapy against CRPC is commonly administered in combination with androgen-deprivation treatment (ADT) and, in some cases, with daily, low-dose corticosteroids. Importantly, the use of low-dose corticosteroids is associated with multiple negative effects, including reduced muscle mass. On these grounds, we hypothesized that the chronic use of corticosteroids may increase the incidence of fatigue in patients with prostate cancer. We reviewed all randomized trials published during the last 15years conducted in patients with prostate cancer receiving systemic treatment and we performed a sub-group analysis to gather insights regarding the potential differences in the incidence of fatigue in patients receiving vs. not receiving daily corticosteroids as part of their systemic anti-neoplastic regimen. Overall, 22,734 men enrolled in prospective randomized phase II and III trials were evaluable for fatigue. Estimated pooled incidence of grade 1-2 fatigue was 30.89% (95% CI = 25.34-36.74), while estimated pooled incidence of grade 3-4 fatigue was reported in 3.90% (95% CI = 2.91-5.02). Sub-group analysis showed that grade 3-4 fatigue was approximately double in patients who received daily corticosteroids as part of their anti-neoplastic treatment (5.58; 95% CI = 4.33-6.98) vs. those who did not (2.67%; 95% CI = 1.53-4.11). Our findings highlight the need for ad hoc-designed prospective clinical trials to investigate whether the benefits associated with low-dose, daily corticosteroids outweigh the risks associated with corticosteroid-related adverse events such as fatigue.

Favorable survival in lung transplant recipients on preoperative low-dose, as compared to high-dose corticosteroids, after hematopoietic stem cell transplantation.

Although the number of patients developing pulmonary complications after hematopoietic stem cell transplantation (HSCT) necessitating lung transplantation (LT) is increasing, a little information is available about factors influencing the prognosis after LT in these patients. Corticosteroids represent the first-line therapy for pulmonary complications after HSCT; however, prolonged corticosteroid treatment prior to LT increases the potential risks of LT. In this study, we assessed the effect of preoperative corticosteroid therapy on long-term survival in patients undergoing LT after HSCT. We retrospectively investigated data from 13 patients who had received high-dose corticosteroid therapy and nine who had received low-dose corticosteroid therapy prior to LT for pulmonary complications after HSCT. Other than the preoperative corticosteroid dose, patient clinical characteristics did not differ. The incidence of postoperative complications within the first year after LT was significantly lower in the low-dose corticosteroid group (p=0.026). Survival after LT was also significantly better in the low-dose corticosteroid group than in the high-dose corticosteroid group (p=0.034). In recipients of LT after HSCT, preoperative low-dose corticosteroid use, as compared to preoperative high-dose corticosteroid use, could limit the risks of postoperative complications developing within the first year after the LT, leading to improved long-term survival after LT.

Diagnosis of Autoimmune Pancreatitis: The Evolution of Diagnostic Criteria for a Rare Disease

Diagnosis of Autoimmune Pancreatitis: The Evolution of Diagnostic Criteria for a Rare Disease

Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients.

The relationship between low-dose corticosteroid use and mortality in patients with severe community-acquired pneumonia (CAP) remains unclear. 6925 patients with severe CAP who received mechanical ventilation with or without shock (defined as use of catecholamines) at 983 hospitals were identified using a Japanese nationwide administrative database. The main outcome measure was 28-day mortality. 2524 patients with severe CAP who received catecholamines were divided into corticosteroid (n=631) and control (n=1893) groups. The 28-day mortality was significantly different between corticosteroid and control groups (unmatched: 24.6% versus 36.3%, p<0.001; propensity score-matched: 25.3% versus 32.6%, p=0.01; inverse probability-weighted: 27.5% versus 34.2%, p<0.001). 4401 patients with severe CAP who did not receive catecholamines were also divided into corticosteroid (n=1112) and control (n=3289) groups. The 28-day mortality was not significantly different between corticosteroid and control groups in propensity score-matched analyses (unmatched: 16.0% versus 19.4%, p=0.01; propensity score-matched: 17.7% versus 15.6%, p=0.22; inverse probability-weighted: 18.8% versus 18.2%, p=0.44). Low-dose corticosteroid use may be associated with reduced 28-day mortality in patients with septic shock complicating CAP.

THU0272 Pathological Correlations of Sonographic Subclinical Synovitis in Patients with Rheumatoid Arthritis in Clinical Remission

BackgroundWe recently observed that 45% of patients with RA in clinical remission had ultrasound-defined synovitis (grade 2 or higher synovial hypertrophy (SH) and power Doppler signal). These patients had greater...

クリゾチニブによる好中球減少に対し少量の副腎皮質ステロイド剤を使用したanaplastic lymphoma kinase遺伝子転座陽性肺癌の1例

背景．クリゾチニブの有害事象の1つとして好中球減少が報告されているがその機序は不明である．症例．46歳男性．心タンポナーデを発症し，癌性心膜炎および脳転移を有する肺腺癌と診断された．心膜癒着術および全脳放射線照射施行後にカルボプラチンとペメトレキセドによる化学療法を2コース施行したがprogressive diseaseとなった．その後，anaplastic lymphoma kinase（ALK）遺伝子転座陽性と判明し，クリゾチニブ500 mg/日を開始した．2週間で腫瘍縮小効果を認めたが，同時にgrade 3の好中球減少を合併し，休薬後も遷延した．プレドニゾロン10 mg/日を開始後，好中球減少は速やかに改善した．クリゾチニブ同量での再開が可能となり，治療再開6ヶ月後も著効を得ている．結論．クリゾチニブによる好中球減少に対し，少量のステロイド剤が有効でクリゾチニブ投与継続が可能となった1例を経験した.

S16 Outcomes in idiopathic pulmonary fibrosis: a meta-analysis from placebo controlled trials

BackgroundMuch of the data regarding the natural history of Idiopathic pulmonary fibrosis (IPF) pre-dates current clinical criteria. Despite high mortality debate has been sparked recently regarding the appropriateness of mortality...

Update on the Use of Steroids in Rheumatoid Arthritis

Corticosteroids are a mainstay in the therapy of rheumatoid arthritis (RA). In recent years, a number of high-quality controlled clinical trials have shown their effect as a disease-modifying anti-rheumatic drug (DMARD) and a favorable safety profile in recent-onset RA. Despite this, they are more frequently used as bridge therapy while other DMARDs initiate their action than as true disease-modifying agents. Low-dose corticosteroid use during the first two years of disease slows radiologic damage and reduces the need of biologic therapy aimed at reaching a state of clinical remission in recent-onset RA. Thus, their systematic use in this clinical scenario should be considered.

AB0463 Cutanoeous vasculitis associated to severe infection: study of 27 patients

BackgroundCutaneous vasculitis (CV) can be a clinical manifestation of a severe infection. In such cases a delayed diagnosis or the use of immunosuppressive therapy may impair the prognosis.ObjectivesOur objective was...