Dixon WG, Abrahamowicz M, Beauchamp ME et al.
University of Manchester, Manchester, UK.
Ann Rheum Dis 2012 Jan 12; Epub ahead of print.
Editor’s note: Glucocorticoids remain the mainstay of therapy in rheumatoid arthritis (RA) and are currently the only viable option for rescue or bridging therapy between disease-modifying therapies. Concerns remain about the potential side-effects of steroid use, including the risk of cardiovascular disease, diabetes, weight gain, cataracts, and osteoporosis. There are questions about the degree of risk of glucocorticoid therapy, whether the adverse risk outcome is dependent on treatment regimens, and what happens upon stopping therapy. Serious infection is a cause of major mortality in patients with RA. Glucocorticoids impair phagocyte function and suppress cell-mediated immunity. It is known that high-dose glucocorticoid therapy is associated with an increased risk of infection and other diseases, but the effect of the lower doses we commonly use in RA is less clear. A number of models have been used to quantify the infection risk associated with glucocorticoid therapy, but they do not take into account the pattern of drug use over time – this is an important issue in RA, in which doses may be continually increased, reduced, or stopped.