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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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