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Low-dose glucocorticoids (GCs) improve symptoms and physical function and reduce joint damage in rheumatoid arthritis (RA).1 Over a third of patients with RA are managed with long-term oral GC, defined as daily use for ≥3 months.2 Current RA management guidelines recommend tapering GCs to the lowest effective dose as quickly as possible3 4 to minimise risk of GC-associated side effects, such as infections, cardiovascular events and bone fractures. However, there is little evidence to guide clinicians attempting to taper GCs,5 6 leading to widely variable practice patterns. This is of particular importance for patients with established RA who are maintained on long-term GCs. Such patients have higher cumulative GC exposure and increased rates of cardiovascular disease, osteoporosis and insulin resistance relative to early patients with RA, …
Handling editor Josef S Smolen
Contributors BIW: study conception and design, interpretation of data, drafting of the manuscript and final approval of the manuscript. DMW: data acquisition, critical revision of the manuscript and final approval of the manuscript. AKW: study conception, critical revision of the manuscript and final approval of the manuscript. DJC: study conception, critical revision of the manuscript and final approval of the manuscript.
Funding Dr. Wallace was supported during the time of this research by a VA Advanced Fellowship in Health Services Research and Development.
Competing interests Dr Clauw reports consulting relationships with Aptinyx, Daiichi Snakyo, Intec Pharma, EliLilly, Pfizer, Samumed, Theravance, Tonix, Zynerba; has served as expert witness for Nix Patterson LLP, Williams & Connolly LLP; receives research support from Aptinyx, Pfizer.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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