title: Use of glucocorticoids in rheumatoid arthritis - pratical modalities of glucocorticoid therapy: recommendations for clinical practice based on data from the literature and expert opinion.
abstract: OBJECTIVE
  To develop recommendations about the use of glucocorticoids in patients with established rheumatoid arthritis (RA) managed in everyday practice, using the evidence-based approach and expert opinion.
  
  
  METHODS
  A three-step procedure was used: a scientific committee used a Delphi procedure to select five questions, which formed the basis for developing the recommendations; a systematic literature review was conducted by searching the Medline and Embase databases and the abstracts of meetings held by the Société Française de Rhumatologie (SFR), American College of Rheumatology (ACR), and European League Against Rheumatism (EULAR); and recommendations were developed and validated by a panel of experts based on the data from the literature review and on their experience. For each recommendation, the level of evidence and extent of agreement among experts were determined.
  
  
  RESULTS
  The five questions pertained to the use of glucocorticoids in RA patients: role for intravenous glucocorticoid bolus therapy, role for intraarticular injections, and practical modalities of glucocorticoid administration and discontinuation. From the literature search, 93 articles were selected based on their titles and abstracts. Of these, 50 were selected for the literature review. Eight recommendations about the use of glucocorticoid therapy in everyday practice in patients with established RA were validated by a vote among all participating experts: bolus glucocorticoid therapy should be reserved for highly selected situations; triamcinolone hexacetonide is the preferred glucocorticoid for intraarticular therapy, and the joint should be rested for about 24h after the injection; for oral glucocorticoid therapy, agents with a short half-life taken once daily should be preferred; and when discontinuing glucocorticoid therapy, the patient and usual physician should be informed of the risk of adrenal insufficiency.
authors.affiliation: Service de rhumatologie, centre hospitalier Le Mans, 72037 Le Mans, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Dernis
authors.forename: Adeline
authors.initials: A
authors.lastname: Ruyssen-Witrand
authors.forename: Gaël
authors.initials: G
authors.lastname: Mouterde
authors.forename: Jean-Francis
authors.initials: JF
authors.lastname: Maillefert
authors.forename: Jacques
authors.initials: J
authors.lastname: Tebib
authors.forename: Alain
authors.initials: A
authors.lastname: Cantagrel
authors.forename: Pascal
authors.initials: P
authors.lastname: Claudepierre
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaudin
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
authors.forename: Thierry
authors.initials: T
authors.lastname: Schaeverbeke
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.forename: Xavier Le
authors.initials: XL
authors.lastname: Loët
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007103:Immobilization; D007270:Injections, Intra-Articular; D008775:Methylprednisolone / Q000008:administration & dosage; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide; D008775:Methylprednisolone