Effects of long-term glucocorticoid therapy in rheumatoid arthritis.

Radiographic erosions develop in about two thirds of patients with rheumatoid arthritis (RA). Glucocorticoids offer rapid and substantial control of the symptoms of inflammation in the short and medium term. Data are reviewed which suggest that this benefit may not last into the longer term (more than 1 year). However, recent studies provide unequivocal evidence that joint destruction can be halted in this disease. Also, by separating the short-term anti-inflammatory effect from a more prolonged suppression of joint destruction, these studies have shed light on the underlying pathological processes. The evidence from these therapeutic clinical trials strengthens the view that inflammation and joint destruction are parallel processes, loosely linked by the underlying cause of RA, but progressing to some extent independently. It is intriguing to speculate that different effects of glucocorticoids might relate to their different modes of action outlined elsewhere in this symposium.