Article Text

EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases
  1. N Duru1,
  2. M C van der Goes1,
  3. J W G Jacobs1,
  4. T Andrews2,
  5. M Boers3,
  6. F Buttgereit4,
  7. N Caeyers5,
  8. M Cutolo6,
  9. S Halliday2,
  10. J A P Da Silva7,
  11. J R Kirwan8,
  12. D Ray9,
  13. J Rovensky10,
  14. G Severijns5,
  15. R Westhovens11,
  16. J W J Bijlsma1
  1. 1Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2EULAR Social Leagues Patients’ Representative, Bristol, UK
  3. 3Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
  4. 4Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
  5. 5EULAR Social Leagues Patients’ Representative, Leuven, Belgium
  6. 6Research Laboratory and Division of Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
  7. 7Department of Reumatologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  8. 8University of Bristol Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol, UK
  9. 9Centre for Endocrinology and Diabetes, Institute for Human Development, University of Manchester, and Manchester Academic Health Sciences Centre, Manchester, UK
  10. 10National Institute of Rheumatic Diseases, Piest'any, Slovakia
  11. 11Rheumatology, Department of Development and Regeneration, Neuro-musculo-skeletal Research Unit, KU Leuven, Leuven, Belgium
  1. Correspondence to M C van der Goes, Department of Rheumatology & Clinical Immunology (F02.127), University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; m.c.vandergoes{at}


To develop recommendations for the management of medium to high-dose (ie, >7.5 mg but ≤100 mg prednisone equivalent daily) systemic glucocorticoid (GC) therapy in rheumatic diseases.

A multidisciplinary EULAR task force was formed, including rheumatic patients. After discussing the results of a general initial search on risks of GC therapy, each participant contributed 10 propositions on key clinical topics concerning the safe use of medium to high-dose GCs. The final recommendations were selected via a Delphi consensus approach. A systematic literature search of PubMed, EMBASE and Cochrane Library was used to identify evidence concerning each of the propositions. The strength of recommendation was given according to research evidence, clinical expertise and patient preference.

The 10 propositions regarded patient education and informing general practitioners, preventive measures for osteoporosis, optimal GC starting dosages, risk-benefit ratio of GC treatment, GC sparing therapy, screening for comorbidity, and monitoring for adverse effects. In general, evidence supporting the recommendations proved to be surprisingly weak. One of the recommendations was rejected, because of conflicting literature data.

Nine final recommendations for the management of medium to high-dose systemic GC therapy in rheumatic diseases were selected and evaluated with their strengths of recommendations. Robust evidence was often lacking; a research agenda was created.

  • Corticosteroids
  • Autoimmune Diseases
  • Treatment

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