RT Journal Article
SR Electronic
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
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 952
OP 957
DO 10.1136/annrheumdis-2015-208916
VO 75
IS 6
A1 Cindy Strehl
A1 Johannes W J Bijlsma
A1 Maarten de Wit
A1 Maarten Boers
A1 Nele Caeyers
A1 Maurizio Cutolo
A1 Bhaskar Dasgupta
A1 William G Dixon
A1 Rinie Geenen
A1 Tom W J Huizinga
A1 Alison Kent
A1 Annette Ladefoged de Thurah
A1 Joachim Listing
A1 Xavier Mariette
A1 David W Ray
A1 Hans U Scherer
A1 Raphaèle Seror
A1 Cornelia M Spies
A1 Simon Tarp
A1 Dieter Wiek
A1 Kevin L Winthrop
A1 Frank Buttgereit
YR 2016
UL http://ard.bmj.com/content/75/6/952.abstract
AB 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.