title: The intelligent use of systemic glucocorticoids in rheumatoid arthritis.
abstract: Glucocorticoids (GC) have potent anti-inflammatory and immunomodulatory effects and are widely used in the management of rheumatoid arthritis in combination with other disease-modifying anti-rheumatoid drugs. Concern about the risk of adverse effects may be to some extent misplaced as low to moderate doses of GC have different mechanisms of action and risk profiles compared with high doses. This review discusses the current understanding about the different modes of action of GC, their strong disease-modifying properties and the efforts at improving the therapeutic ratio of GC through the development of new drugs which promise greater safety such as selective GC receptor agonists, liposomal GC and modified-release (MR) prednisone.
authors.affiliation: University of Bristol Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Mercieca
authors.forename: John R
authors.initials: JR
authors.lastname: Kirwan
mesh_terms: D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology / Q000628:therapy; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D011241:Prednisone / Q000627:therapeutic use*
chemical_list: D003692:Delayed-Action Preparations; D005938:Glucocorticoids; D011241:Prednisone