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Dose-related patterns of glucocorticoid-induced side effects
  1. Dörte Huscher (huscher{at}
  1. German Rheumatism Research Centre, Germany
    1. Katja Thiele (thiele{at}
    1. German Rheumatism Research Centre, Germany
      1. Erika Gromnica-Ihle (erika{at}
      1. private practice, Berlin, Germany
        1. Gert Hein (gert.hein{at}
        1. Friedrich-Schiller-University Jena, Germany
          1. Winfried Demary (demary{at}
          1. private practice, Hildesheim, Germany
            1. Reiner Dreher (professor{at}
            1. private practice, Bad Kreuznach, Germany
              1. Angela Zink (zink{at}
              1. German Rheumatism Research Centre, Germany
                1. Frank Buttgereit (frank.buttgereit{at}
                1. Dept of Rheumatology & Immunology, Germany


                  Objective: To identify patterns of self-reported health problems relating to dose and duration of GC intake in unselected patients with rheumatoid arthritis from routine practice.

                  Methods: We analyzed data from 1,066 patients. 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 GC treatment for >6 months and current doses of <5, 5-7.5 and >7.5 mg/d prednisone equivalent were compared to a group without any GC treatment for at least 12 months.

                  Results: The frequency of self-reported health problems was lowest in the group without GC exposition and increased with dosage. We observed two distinct dose-related patterns of adverse events: 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 >7.5mg/d for glaucoma, depression/ listlessness and increase of blood pressure. Dosages of 5 mg/d or more were associated with epistaxis and weight gain. A very low threshold was seen for eye cataract (<5 mg/d).

                  Conclusion: The associations found are in agreement with biologic mechanisms and clinical observations. Since there is a paucity of real-life data on adverse effects of GCs prescribed to unselected groups of patients, our data may help the clinician to adapt therapy with GC accordingly and improve the benefit-risk-ratio.

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