Table 1

European League Against Rheumatism (EULAR) evidence-based recommendations on systemic glucocorticoid therapy in rheumatic diseases12

RecommendationCriteria
1aThe adverse effects of GC therapy should be considered and discussed with the patient before GC therapy is started
1bThis advice should be reinforced by giving information regarding GC management
1cIf GCs are to be used for a more prolonged period of time, a ‘GC card’ is to be issued to every patient, with the date of commencement of treatment, the initial dosage and the subsequent reductions and maintenance regimens
2aInitial dose, dose reduction and long-term dosing depend on the underlying rheumatic disease, disease activity, risk factors and individual responsiveness of the patient
2bTiming may be important, with respect to the circadian rhythm of the disease and the natural secretion of GCs
3When it is decided to start GC treatment, comorbidities and risk factors for adverse effects should be evaluated and treated where indicated; these include hypertension, diabetes, peptic ulcer, recent fractures, presence of cataract or glaucoma, presence of (chronic) infections, dyslipidaemia and comedication with non-steroidal anti-inflammatory drugs
4For prolonged treatment, the GC dosage should be kept to a minimum and a GC taper should be attempted in case of remission or low disease activity; the reasons to continue GC therapy should be regularly checked
5During treatment, patients should be monitored for body weight, blood pressure, peripheral oedema, cardiac insufficiency, serum lipids, blood and/or urine glucose and ocular pressure depending on individual patient's risk, GC dose and duration
6aIf a patient is given prednisone ≥7.5 mg daily and continues on prednisone for more than 3 months, calcium and vitamin D supplementation should be prescribed.
6bAntiresorptive therapy with bisphosphonates to reduce the risk of GC-induced osteoporosis should be based on risk factors, including bone mineral density measurement
7Patients treated with GCs and concomitant non-steroidal anti-inflammatory drugs should be given appropriate gastroprotective medication, such as proton pump inhibitors or misoprostol, or alternatively could switch to a cyclo-oxygenase-2 selective inhibitor
8All patients on GC therapy for longer than 1 month, who will undergo surgery, need perioperative management with adequate GC replacement to overcome potential adrenal insufficiency
9GCs during pregnancy have no additional risk for mother and child
10Children receiving GCs should be checked regularly for linear growth and considered for growth hormone replacement in case of growth impairment
  • GC, glucocorticoid.