Abstract
At present, growing scientific evidence from the medical literature and expert opinion provides strong consideration for a mandatory role of glucocorticoids (GCs) in the management of rheumatoid arthritis (RA). Earlier application strategies were based on initial high doses, with subsequent tapering schedules, resulting in dose-related side effects. Recent low-dose GC schemes are more feasible in routine care, while providing evidence of clinical, functional and structural efficacy. Thus, initial low-dose GC 'bridging' treatment on a disease- modifying antirheumatic drug background should be included in any existing recommendations for RA management, as very recently advocated by the EULAR Task Force 2013 updated guidelines. Long-term low-dose therapy appears to provide acceptable safety, leading to long-standing slowing of structural damage, seen even after GC therapy withdrawal. Gaps in knowledge about the optimal method to taper and possibly discontinue GC treatment remain, and this topic should be addressed in clinical trials and observational studies. Recent efforts in GC medication have also included the introduction of a modified-release drug formulation capable of drug delivery consistent with chronobiological pathogenetic rhythms of disease, which has been quite efficacious in controlling the signs and symptoms related to pathways of circadian cytokines. Long-term data will further clarify the add-on benefits of such modified-release formulations.
| Original language | English |
|---|---|
| Pages (from-to) | 104-111 |
| Number of pages | 8 |
| Journal | NeuroImmunoModulation |
| Volume | 22 |
| DOIs | |
| Publication status | Published - Nov 7 2014 |
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Keywords
- Disease-modifying antirheumatic drugs
- Glucocorticoids
- Rheumatoid arthritis
ASJC Scopus subject areas
- Endocrinology
- Immunology
- Endocrine and Autonomic Systems
- Neurology
- Medicine(all)
Cite this
Oral low-dose glucocorticoids should be included in any recommendation for the use of non-biologic and biologic disease-modifying antirheumatic drugs in the treatment of rheumatoid arthritis. / Caporali, Roberto; Todoerti, Monica; Scirè, Carlo Alberto; Montecucco, Carlomaurizio; Cutolo, Maurizio.
In: NeuroImmunoModulation, Vol. 22, 07.11.2014, p. 104-111.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Oral low-dose glucocorticoids should be included in any recommendation for the use of non-biologic and biologic disease-modifying antirheumatic drugs in the treatment of rheumatoid arthritis
AU - Caporali, Roberto
AU - Todoerti, Monica
AU - Scirè, Carlo Alberto
AU - Montecucco, Carlomaurizio
AU - Cutolo, Maurizio
PY - 2014/11/7
Y1 - 2014/11/7
N2 - At present, growing scientific evidence from the medical literature and expert opinion provides strong consideration for a mandatory role of glucocorticoids (GCs) in the management of rheumatoid arthritis (RA). Earlier application strategies were based on initial high doses, with subsequent tapering schedules, resulting in dose-related side effects. Recent low-dose GC schemes are more feasible in routine care, while providing evidence of clinical, functional and structural efficacy. Thus, initial low-dose GC 'bridging' treatment on a disease- modifying antirheumatic drug background should be included in any existing recommendations for RA management, as very recently advocated by the EULAR Task Force 2013 updated guidelines. Long-term low-dose therapy appears to provide acceptable safety, leading to long-standing slowing of structural damage, seen even after GC therapy withdrawal. Gaps in knowledge about the optimal method to taper and possibly discontinue GC treatment remain, and this topic should be addressed in clinical trials and observational studies. Recent efforts in GC medication have also included the introduction of a modified-release drug formulation capable of drug delivery consistent with chronobiological pathogenetic rhythms of disease, which has been quite efficacious in controlling the signs and symptoms related to pathways of circadian cytokines. Long-term data will further clarify the add-on benefits of such modified-release formulations.
AB - At present, growing scientific evidence from the medical literature and expert opinion provides strong consideration for a mandatory role of glucocorticoids (GCs) in the management of rheumatoid arthritis (RA). Earlier application strategies were based on initial high doses, with subsequent tapering schedules, resulting in dose-related side effects. Recent low-dose GC schemes are more feasible in routine care, while providing evidence of clinical, functional and structural efficacy. Thus, initial low-dose GC 'bridging' treatment on a disease- modifying antirheumatic drug background should be included in any existing recommendations for RA management, as very recently advocated by the EULAR Task Force 2013 updated guidelines. Long-term low-dose therapy appears to provide acceptable safety, leading to long-standing slowing of structural damage, seen even after GC therapy withdrawal. Gaps in knowledge about the optimal method to taper and possibly discontinue GC treatment remain, and this topic should be addressed in clinical trials and observational studies. Recent efforts in GC medication have also included the introduction of a modified-release drug formulation capable of drug delivery consistent with chronobiological pathogenetic rhythms of disease, which has been quite efficacious in controlling the signs and symptoms related to pathways of circadian cytokines. Long-term data will further clarify the add-on benefits of such modified-release formulations.
KW - Disease-modifying antirheumatic drugs
KW - Glucocorticoids
KW - Rheumatoid arthritis
UR - http://www.scopus.com/inward/record.url?scp=84908600395&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84908600395&partnerID=8YFLogxK
U2 - 10.1159/000362730
DO - 10.1159/000362730
M3 - Article
C2 - 25227117
AN - SCOPUS:84908600395
VL - 22
SP - 104
EP - 111
JO - NeuroImmunoModulation
JF - NeuroImmunoModulation
SN - 1021-7401
ER -