Dose-related patterns of glucocorticoid-induced side effects
- 1German Rheumatism Research Centre Berlin, Berlin, Germany
- 2Rheumatologist in private practice, Berlin, Germany
- 3Department of Rheumatology and Osteology, University Hospital, Jena, Germany
- 4Rheumatologist in private practice, Hildesheim, Germany
- 5Rheumatologist in private practice, Bad Kreuznach, Germany
- 6Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
- D Huscher, German Rheumatism Research Centre Berlin, Epidemiology Unit, Charitéplatz 1, 10117 Berlin, Germany;
- Accepted 26 July 2008
- Published Online First 6 August 2008
Objective: To identify patterns of self-reported health problems relating to dose and duration of glucocorticoid intake in unselected patients with rheumatoid arthritis from routine practice.
Methods: Data from 1066 patients were analysed. The clinical status and drug treatment were reported by the physician, health problems during the past 6 months by the patient using a comprehensive list of symptoms. Patients with ongoing glucocorticoid treatment for more than 6 months and current doses of less than 5, 5–7.5 and over 7.5 mg/day prednisone equivalent were compared with a group without any glucocorticoid treatment for at least 12 months.
Results: The frequency of self-reported health problems was lowest in the group without glucocorticoid exposition and increased with dosage. Two distinct dose-related patterns of adverse events were observed. A “linear” rising with increasing dose was found for cushingoid phenotype, ecchymosis, leg oedema, mycosis, parchment-like skin, shortness of breath and sleep disturbance. A “threshold pattern” describing an elevated frequency of events beyond a certain threshold value was observed at dosages of over 7.5 mg/day for glaucoma, depression/listlessness and increase in blood pressure. Dosages of 5 mg/day or more were associated with epistaxis and weight gain. A very low threshold was seen for eye cataract (<5 mg/day).
Conclusion: The associations found are in agreement with biological mechanisms and clinical observations. As there is a paucity of real-life data on adverse effects of glucocorticoids prescribed to unselected groups of patients, these data may help the clinician to adapt therapy with glucocorticoids accordingly and improve the benefit–risk ratio.
Funding: Funded by the German Federal Minister of Health from 1993 to 1999 (FB2-433346–8/13) and by the German Federal Minister of Education and Research within the “Competence Network Rheumatology” from 1999 to 2007 (01GI0344/3). FB's work has been supported by the Berlin Center of Regenerative Therapies.
Competing interests: None.
Ethics approval: Ethics approval was obtained.
Patient consent: Obtained.