CORTICOSTEROIDS IN RHEUMATOID-ARTHRITIS - HOW BEST TO USE THEM

Glucocorticosteroids are widely used in the treatment of patients with rheumatoid arthritis. Initially there was much enthusiasm for their use, arising from the striking relief of symptoms seen in patients with rheumatoid arthritis treated with corticosteroids. When the wide array of potentially serious adverse effects became apparent, the use of corticosteroids decreased. More recently, however, the careful use of corticosteroids in patients with rheumatoid arthritis has been generally accepted. New insights into the mechanisms of action of corticosteroids, especially their effects on the immune system and the hypothalamic-pituitary-adrenal axis, have provided more insight into, and rationale for, the use of corticosteroids in rheumatoid arthritis. Clinical data on the effectiveness of low dosage oral corticosteroids, high dosage systemic corticosteroids and intra-articular injections of corticosteroids are scarce, In contrast, data on the adverse effects of oral low dosage corticosteroids are abundant. In the last few years, strategies have been developed to at least partially prevent 2 of the main adverse effects: peptic ulcer disease and osteoporosis. Some practical guidelines on the use of corticosteroids in the management of rheumatoid arthritis conclude this review.