Use of glucocorticoids in rheumatoid arthritis - pratical modalities of glucocorticoid therapy: recommendations for clinical practice based on data from the literature and expert opinion.
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.
Dernis
Emmanuelle
E
Service de rhumatologie, centre hospitalier Le Mans, 72037 Le Mans, France.
Ruyssen-Witrand
Adeline
A
Mouterde
Gaël
G
Maillefert
Jean-Francis
JF
Tebib
Jacques
J
Cantagrel
Alain
A
Claudepierre
Pascal
P
Fautrel
Bruno
B
Gaudin
Philippe
P
Pham
Thao
T
Schaeverbeke
Thierry
T
Wendling
Daniel
D
Saraux
Alain
A
Loët
Xavier Le
XL
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
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide; D008775:Methylprednisolone