RT Journal Article
SR Electronic
T1 EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 1905
OP 1913
DO 10.1136/annrheumdis-2013-203249
VO 72
IS 12
A1 N Duru
A1 M C van der Goes
A1 J W G Jacobs
A1 T Andrews
A1 M Boers
A1 F Buttgereit
A1 N Caeyers
A1 M Cutolo
A1 S Halliday
A1 J A P Da Silva
A1 J R Kirwan
A1 D Ray
A1 J Rovensky
A1 G Severijns
A1 R Westhovens
A1 J W J Bijlsma
YR 2013
UL http://ard.bmj.com/content/72/12/1905.abstract
AB 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.