title: Indications of glucocorticoids in early arthritis and rheumatoid arthritis: recommendations for clinical practice based on data from the literature and expert opinion.
abstract: OBJECTIVE
  To develop clinical practice guidelines about the indications of glucocorticoid therapy in early arthritis and established rheumatoid arthritis, based on previously published data and on the opinions of rheumatology experts.
  
  
  METHODS
  We used a three-step procedure. (a) A scientific committee used a Delphi procedure to select three questions about glucocorticoid indications: what is the role for glucocorticoid therapy in early arthritis? What is the role for long-term glucocorticoid therapy in established rheumatoid arthritis? What is the role for systemic glucocorticoid therapy in flares of rheumatoid arthritis? (b) Evidence providing answers to the three questions was sought in Pubmed, Embase, Cochrane, and abstracts from the annual meetings of the ACR and EULAR. (c) Based on this evidence, recommendations were developed and validated by a panel of experts. The strength of each recommendation was determined based on the level of the underlying evidence. The level of agreement among experts regarding each recommendation was measured.
  
  
  RESULTS
  The literature search retrieved 2851 publications, of which 36 were selected based on the titles and abstracts then on the full-length articles. These 36 studies were presented to the experts as a basis for discussion. Six recommendations rated A to D were developed and validated by the experts. They dealt with the appropriateness of low- or moderate-dose glucocorticoid therapy for a limited period in early polyarthritis after advice from a specialist and in the event of active disease, in combination with disease-modifying antirheumatic drug (DMARD) therapy; the appropriateness of low-dose glucocorticoid therapy (no more than 0.1mg/kg/day) in RA if needed to achieve symptom control; and the appropriateness of oral glucocorticoid therapy (no more than 0.5mg/kg/day) for 1 to 2 weeks in polyarticular flares of RA.
  
  
  CONCLUSIONS
  The six recommendations for everyday practice presented here should help to standardize and to optimize clinical practice, thereby improving the management of patients with early arthritis or RA.
authors.affiliation: Service d'immuno-rhumatologie, CHU Lapeyronie, Montpellier, France. gaelmouterde@live.fr
authors.forename: Gaël
authors.initials: G
authors.lastname: Mouterde
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Dernis
authors.forename: Adeline
authors.initials: A
authors.lastname: Ruyssen-Witrand
authors.forename: Pascal
authors.initials: P
authors.lastname: Claudepierre
authors.forename: Thierry
authors.initials: T
authors.lastname: Schaeverbeke
authors.forename: Alain
authors.initials: A
authors.lastname: Cantagrel
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaudin
authors.forename: Jean-Francis
authors.initials: JF
authors.lastname: Maillefert
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.forename: Jacques
authors.initials: J
authors.lastname: Tebib
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loët
mesh_terms: D001168:Arthritis / Q000188:drug therapy; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D016206:Databases, Bibliographic; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000627:therapeutic use*; D006287:Health Planning Guidelines; D006801:Humans; D017410:Practice Guidelines as Topic; D013997:Time Factors
chemical_list: D005938:Glucocorticoids