75 years after the first reports on the remarkable effects of cortisone in treating rheumatoid arthritis, glucocorticoids remain essential in managing RA.
Cortisone continues to be highly relevant and widely used in the treatment of RA and other immune-mediated inflammatory diseases.
The mechanisms leading to the efficacy vs toxicity of glucocorticoids are still unclear, presenting a challenge for future treatments.
Some studies have shown that low doses of glucocorticoids are effective in disease control with relatively low risk.
Rheumatology societies generally recommend minimizing glucocorticoid use and discontinuing therapy whenever possible.
Clinicians are exploring different tapering options for glucocorticoids across various diseases, aiming to reduce cumulative use and minimize toxicity.
Glucocorticoids (GCs) have been in use for 75 years for the management of rheumatoid arthritis (RA) and other immune-mediated inflammatory diseases, with low doses proving effective as anti-inflammatory and anti-destructive agents. While the mechanisms of efficacy and toxicity remain unclear, efforts are ongoing to find better alternatives to GCs. Rheumatology societies recommend minimizing GC use and discontinuing it whenever possible due to the associated adverse effects, such as Cushing syndrome, hypertension, and osteoporosis. Studies have shown that very low doses of GCs may still play a role in treatment, with some suggesting a combination of low-dose GCs with other medications for improved outcomes.
Clinicians are advised to attempt to discontinue GC use whenever possible and consider alternative therapies to reduce the cumulative use of GCs over time. Monitoring for GC toxicity and addressing adrenal insufficiency symptoms upon tapering off GCs are important considerations. Patient education and collaboration with other providers are crucial in managing AI symptoms and potential adverse effects. Research is ongoing to develop safer alternatives to GCs for long-term use in the treatment of various inflammatory conditions.
