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

Cindy Strehl, Johannes W J Bijlsma, Maarten de Wit, Maarten Boers, Nele Caeyers, Maurizio Cutolo, Bhaskar Dasgupta, William G. Dixon, Rinie Geenen, Tom W J Huizinga, Alison Kent, Annette Ladefoged de Thurah, Joachim Listing, Xavier Mariette, David W. Ray, Hans U. Scherer, Raphaèle Seror, Cornelia M. Spies, Simon Tarp, Dieter WiekKevin Winthrop, Frank Buttgereit

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalAnnals of the Rheumatic Diseases
DOIs
StateAccepted/In press - Mar 1 2016

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Advisory Committees
Glucocorticoids
Rheumatic Diseases
Therapeutics
Cardiovascular Infections
Prednisone
Hyperglycemia
Osteoporosis
Medical problems
Consensus
Diabetes Mellitus
Cardiovascular Diseases
Guidelines

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Allergy

Cite this

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. / Strehl, Cindy; Bijlsma, Johannes W J; de Wit, Maarten; Boers, Maarten; Caeyers, Nele; Cutolo, Maurizio; Dasgupta, Bhaskar; Dixon, William G.; Geenen, Rinie; Huizinga, Tom W J; Kent, Alison; de Thurah, Annette Ladefoged; Listing, Joachim; Mariette, Xavier; Ray, David W.; Scherer, Hans U.; Seror, Raphaèle; Spies, Cornelia M.; Tarp, Simon; Wiek, Dieter; Winthrop, Kevin; Buttgereit, Frank.

In: Annals of the Rheumatic Diseases, 01.03.2016.

Research output: Contribution to journalArticle

Strehl, C, Bijlsma, JWJ, de Wit, M, Boers, M, Caeyers, N, Cutolo, M, Dasgupta, B, Dixon, WG, Geenen, R, Huizinga, TWJ, Kent, A, de Thurah, AL, Listing, J, Mariette, X, Ray, DW, Scherer, HU, Seror, R, Spies, CM, Tarp, S, Wiek, D, Winthrop, K & Buttgereit, F 2016, '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', Annals of the Rheumatic Diseases. https://doi.org/10.1136/annrheumdis-2015-208916
Strehl, Cindy ; Bijlsma, Johannes W J ; de Wit, Maarten ; Boers, Maarten ; Caeyers, Nele ; Cutolo, Maurizio ; Dasgupta, Bhaskar ; Dixon, William G. ; Geenen, Rinie ; Huizinga, Tom W J ; Kent, Alison ; de Thurah, Annette Ladefoged ; Listing, Joachim ; Mariette, Xavier ; Ray, David W. ; Scherer, Hans U. ; Seror, Raphaèle ; Spies, Cornelia M. ; Tarp, Simon ; Wiek, Dieter ; Winthrop, Kevin ; Buttgereit, Frank. / 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. In: Annals of the Rheumatic Diseases. 2016.
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