TY - JOUR T1 - Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task force JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 952 LP - 957 DO - 10.1136/annrheumdis-2015-208916 VL - 75 IS - 6 AU - Cindy Strehl AU - Johannes W J Bijlsma AU - Maarten de Wit AU - Maarten Boers AU - Nele Caeyers AU - Maurizio Cutolo AU - Bhaskar Dasgupta AU - William G Dixon AU - Rinie Geenen AU - Tom W J Huizinga AU - Alison Kent AU - Annette Ladefoged de Thurah AU - Joachim Listing AU - Xavier Mariette AU - David W Ray AU - Hans U Scherer AU - Raphaèle Seror AU - Cornelia M Spies AU - Simon Tarp AU - Dieter Wiek AU - Kevin L Winthrop AU - Frank Buttgereit Y1 - 2016/06/01 UR - http://ard.bmj.com/content/75/6/952.abstract N2 - There is convincing evidence for the known and unambiguously accepted beneficial effects of glucocorticoids at low dosages. However, the implementation of existing recommendations and guidelines on the management of glucocorticoid therapy in rheumatic diseases is lagging behind. As a first step to improve implementation, we aimed at defining conditions under which long-term glucocorticoid therapy may have an acceptably low level of harm. A multidisciplinary European League Against Rheumatism task force group of experts including patients with rheumatic diseases was assembled. After a systematic literature search, breakout groups critically reviewed the evidence on the four most worrisome adverse effects of glucocorticoid therapy (osteoporosis, hyperglycaemia/diabetes mellitus, cardiovascular diseases and infections) and presented their results to the other group members following a structured questionnaire for final discussion and consensus finding. Robust evidence on the risk of harm of long-term glucocorticoid therapy was often lacking since relevant study results were often either missing, contradictory or carried a high risk of bias. The group agreed that the risk of harm is low for the majority of patients at long-term dosages of ≤5 mg prednisone equivalent per day, whereas at dosages of >10 mg/day the risk of harm is elevated. At dosages between >5 and ≤10 mg/day, patient-specific characteristics (protective and risk factors) determine the risk of harm. The level of harm of glucocorticoids depends on both dose and patient-specific parameters. General and glucocorticoid-associated risk factors and protective factors such as a healthy lifestyle should be taken into account when evaluating the actual and future risk. ER -