Cyrus Cooper1,2, Thomas Bardin3, Maria-Luisa Brandi4, Patrice Cacoub5,6, John Caminis7, Roberto Civitelli8, Maurizio Cutolo9, Willard Dere10, Jean-Pierre Devogelaer11, Adolfo Diez-Perez12, Thomas A Einhorn13, Patrick Emonts14, Olivier Ethgen15, John A Kanis16, Jean-Marc Kaufman17, Tore K Kvien18, Willem F Lems19, Eugene McCloskey16, Pierre Miossec20, Susanne Reiter21, Johann Ringe22, René Rizzoli23, Kenneth Saag24, Jean-Yves Reginster25. 1. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. cc@mrc.soton.ac.uk. 2. NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. cc@mrc.soton.ac.uk. 3. Department of Rhumatologie, Hôpital Lariboisière Assistance Publique Hôpitaux de Paris, University Paris VII, Paris, France. 4. Department of Internal Medicine, University of Florence, Florence, Italy. 5. Department Hospitalo-Universitaire I2B, INSERM, UMR S 959, CNRS 7211, UPMC University of Paris 06, Paris, France. 6. Group Hospitalier Pitié-Salpêtrière, Department of Internal Medicine, Paris, France. 7. UCB Biosciences, 8010 Arco Corporate Drive, Raleigh, NC, USA. 8. Division of Bone and Mineral Diseases, Washington University, St. Louis, MO, USA. 9. Research Laboratories and Clinical Academic Division of Rheumatology, University Medical School of Genoa, Genoa, Italy. 10. Internal Medicine, University of Utah, Salt Lake City, UT, USA. 11. Rheumatology Department, Saint-Luc University Hospital, Louvain University in Brussels, Brussels, Belgium. 12. Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital del Mar-IMIM and RETICEF, Barcelona, Spain. 13. Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, USA. 14. Bone and Cartilage Metabolism Unit, Department of Public Health Sciences, University of Liege, Liège, Belgium. 15. Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium. 16. Centre for Metabolic Bone Diseases, Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK. 17. Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. 18. Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. 19. Department of Rheumatology, VU University Medical Hospital, Amsterdam, The Netherlands. 20. Immunogenomics and Inflammation Research Unit, Department of Immunology and Rheumatology, University of Lyon 1, Lyon, France. 21. , Bonn, Germany. 22. West German Osteoporosis Center (WOC), University of Cologne, Leverkusen, Germany. 23. Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland. 24. Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham, AL, USA. 25. Department of Public Health, Epidemiology and Health Economics, University of Liege, Liège, Belgium.
Abstract
PURPOSE: This consensus review article considers the question of whether glucocorticoid (GC) therapy is still relevant in the treatment of rheumatic diseases, with a particular focus on rheumatoid arthritis (RA), and whether its side effects can be adequately managed. Recent basic and clinical research on the molecular, cellular and clinical effects of GCs have considerably advanced our knowledge in this field. An overview of the subject seems appropriate. METHODS: This review is the result of a multidisciplinary expert working group, organised by European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. The recent literature was surveyed and the salient evidence synthetized. RESULTS: The pathophysiological basis of RA (and other inflammatory rheumatic diseases) now strongly implicates the adaptive immune system in addition to innate mechanisms. The molecular effect of GCs and differential GC sensitivity is better understood, although exploiting this knowledge is still in its infancy. The newer treatment strategies of early and aggressive control of RA have gr eatly improved clinical outcomes, but improvements are still possible. Newer targeted anti-inflammatory drugs have made an important impact, yet they too are associated with numerous side effects. DISCUSSION: Short durations of moderate doses of GCs are generally well tolerated and have a positive benefit/risk ratio. Patients should be assessed for fracture risk and bone preserving agents and be prescribed calcium and vitamin D supplementation. CONCLUSIONS: Within a strategy of a disease modifying approach to inflammatory disease, combination therapy including a GC is effective approach.
PURPOSE: This consensus review article considers the question of whether glucocorticoid (GC) therapy is still relevant in the treatment of rheumatic diseases, with a particular focus on rheumatoid arthritis (RA), and whether its side effects can be adequately managed. Recent basic and clinical research on the molecular, cellular and clinical effects of GCs have considerably advanced our knowledge in this field. An overview of the subject seems appropriate. METHODS: This review is the result of a multidisciplinary expert working group, organised by European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. The recent literature was surveyed and the salient evidence synthetized. RESULTS: The pathophysiological basis of RA (and other inflammatory rheumatic diseases) now strongly implicates the adaptive immune system in addition to innate mechanisms. The molecular effect of GCs and differential GC sensitivity is better understood, although exploiting this knowledge is still in its infancy. The newer treatment strategies of early and aggressive control of RA have gr eatly improved clinical outcomes, but improvements are still possible. Newer targeted anti-inflammatory drugs have made an important impact, yet they too are associated with numerous side effects. DISCUSSION: Short durations of moderate doses of GCs are generally well tolerated and have a positive benefit/risk ratio. Patients should be assessed for fracture risk and bone preserving agents and be prescribed calcium and vitamin D supplementation. CONCLUSIONS: Within a strategy of a disease modifying approach to inflammatory disease, combination therapy including a GC is effective approach.
Authors: Nicola Veronese; Cyrus Cooper; Jean-Yves Reginster; Marc Hochberg; Jaime Branco; Olivier Bruyère; Roland Chapurlat; Nasser Al-Daghri; Elaine Dennison; Gabriel Herrero-Beaumont; Jean-François Kaux; Emmanuel Maheu; René Rizzoli; Roland Roth; Lucio C Rovati; Daniel Uebelhart; Mila Vlaskovska; André Scheen Journal: Semin Arthritis Rheum Date: 2019-01-11 Impact factor: 5.532
Authors: Chris D Verrico; Shonda Wesson; Vanaja Konduri; Colby J Hofferek; Jonathan Vazquez-Perez; Emek Blair; Kenneth Dunner; Pedram Salimpour; William K Decker; Matthew M Halpert Journal: Pain Date: 2020-09-01 Impact factor: 7.926