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Letter
Evidence to support or guide glucocorticoid tapering in rheumatoid arthritis is lacking
  1. Beth I Wallace1,2,
  2. David M Wallace3,
  3. Akbar K Waljee1,4,
  4. Daniel J Clauw2,5
  1. 1 VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  2. 2 Department of Internal Medicine, Division of Rheumatology, University of Michigan Health System, Ann Arbor, Michigan, USA
  3. 3 Department of Internal Medicine, Division of General Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
  4. 4 Department of Internal Medicine, Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA
  5. 5 Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Beth I Wallace, Department of Internal Medicine, Division of Rheumatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; brennerb{at}umich.edu

http://dx.doi.org/10.1136/annrheumdis-2019-216009

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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, …

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    Footnotes

    • 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.