Glucocorticoid use in rheumatoid arthritis: benefits, mechanisms, and risks.

Glucocorticoids have long been recognized to have beneficial effects in rheumatoid arthritis (RA) (1,2). Several clinical trials over the last decade have further documented the efficacy of glucocorticoids in relieving inflammation and in preventing radiographic erosions in early RA (3-5). Additionally, research has yielded new insights about the cellular mechanisms responsible for these perceived beneficial effects (6,7). Despite potential short term benefits, there is a lack of demonstrated long-term efficacy as well as concerns about short and long-term toxicity. Although these concerns have limited enthusiasm for glucocorticoids by many patients and practitioners, in the U.S. it is estimated that 44% to 75% of RA patients use glucocorticoids (8,9). Confusion and controversy may relate to the fact that toxicity reports are also limited by only modest data quality and quantity. Given growing clinical and basic science evidence supporting the efficacy of glucocorticoids for the treatment of rheumatoid arthritis, their use may further increase. In this review we will examine the latest data supporting the benefits and risks of glucocorticoid use in RA.