title: Glucocorticoid safety for treating rheumatoid arthritis.
abstract: BACKGROUND
  Glucocorticoids (GCs) are often used in the treatment of rheumatoid arthritis and many other inflammatory diseases. Besides strong favorable effects on disease activity, GCs can cause (serious) side effects as well.
  
  
  METHODS
  Side effects of GCs that are ranked as most important by rheumatologists as well as by patients are bone loss and fractures, cardiovascular events, hypertension, and diabetes mellitus. In evaluating these side effects, confounding by indication is a disturbing factor: not only the use of GCs can increase the risk of several side effects, but so can the activity of the underlying disease, which in turn is related to the amount of GCs that is prescribed to the patient.
  
  
  CONCLUSIONS
  Generally, side effects predominantly occur in patients with a high disease activity and when used in high doses and for a long period of time. For these patients, caution and monitoring are most warranted. However, monitoring is not only recommended in patients with a high disease activity, and high-dose or long-term use of GCs, but in all GC users, since side effects may also occur in patients treated with low-dose GCs. When detecting possible negative effects in time, they might be managed and serious damage due to side effects might hopefully be prevented.
authors: VU University Medical Center, Department of Rheumatology , Room 3A54, PO Box 7057, 1007 MB Amsterdam , The Netherlands +31 (0) 20 444 2485 ; +31 (0) 20 444 2138 ; l.rasch@vumc.nl.
authors: Linda A
authors: LA
authors: Rasch
authors: Irene E M
authors: IE
authors: Bultink
authors: Lilian H D
authors: LH
authors: van Tuyl
authors: Willem F
authors: WF
authors: Lems
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D013997:Time Factors
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids
keywords: confounding by indication; glucocorticoids; rheumatoid arthritis; side effects