title: Balancing benefits and risks of glucocorticoids in rheumatic diseases and other inflammatory joint disorders: new insights from emerging data. An expert consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).
abstract: OBJECTIVE
  This consensus review article considers the question of whether glucocorticoid (GC) therapy is still relevant in the treatment of rheumatic diseases, with a particular focus on rheumatoid arthritis (RA), and whether its side effects can be adequately managed. Recent basic and clinical research on the molecular, cellular and clinical effects of GCs have considerably advanced our knowledge in this field. An overview of the subject seems appropriate.
  
  
  METHODS
  This review is the result of a multidisciplinary expert working group, organised by European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. The recent literature was surveyed and the salient evidence synthetized.
  
  
  RESULTS
  The pathophysiological basis of RA (and other inflammatory rheumatic diseases) now strongly implicates the adaptive immune system in addition to innate mechanisms. The molecular effect of GCs and differential GC sensitivity is better understood, although exploiting this knowledge is still in its infancy. The newer treatment strategies of early and aggressive control of RA have gr eatly improved clinical outcomes, but improvements are still possible. Newer targeted anti-inflammatory drugs have made an important impact, yet they too are associated with numerous side effects.
  
  
  CONCLUSIONS
  Short durations of moderate doses of GCs are generally well tolerated and have a positive benefit/risk ratio. Patients should be assessed for fracture risk and bone preserving agents and be prescribed calcium and vitamin D supplementation.
  
  
  CONCLUSIONS
  Within a strategy of a disease modifying approach to inflammatory disease, combination therapy including a GC is effective approach.
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. cc@mrc.soton.ac.uk.|NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK. cc@mrc.soton.ac.uk.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Department of Rhumatologie, Hôpital Lariboisière Assistance Publique Hôpitaux de Paris, University Paris VII, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bardin
authors.affiliation: Department of Internal Medicine, University of Florence, Florence, Italy.
authors.forename: Maria-Luisa
authors.initials: ML
authors.lastname: Brandi
authors.affiliation: Department Hospitalo-Universitaire I2B, INSERM, UMR S 959, CNRS 7211, UPMC University of Paris 06, Paris, France.|Group Hospitalier Pitié-Salpêtrière, Department of Internal Medicine, Paris, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub
authors.affiliation: UCB Biosciences, 8010 Arco Corporate Drive, Raleigh, NC, USA.
authors.forename: John
authors.initials: J
authors.lastname: Caminis
authors.affiliation: Division of Bone and Mineral Diseases, Washington University, St. Louis, MO, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Civitelli
authors.affiliation: Research Laboratories and Clinical Academic Division of Rheumatology, University Medical School of Genoa, Genoa, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cutolo
authors.affiliation: Internal Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Willard
authors.initials: W
authors.lastname: Dere
authors.affiliation: Rheumatology Department, Saint-Luc University Hospital, Louvain University in Brussels, Brussels, Belgium.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Devogelaer
authors.affiliation: Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital del Mar-IMIM and RETICEF, Barcelona, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Diez-Perez
authors.affiliation: Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Einhorn
authors.affiliation: Bone and Cartilage Metabolism Unit, Department of Public Health Sciences, University of Liege, Liège, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Emonts
authors.affiliation: Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: Ethgen
authors.affiliation: Centre for Metabolic Bone Diseases, Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
authors.forename: John A
authors.initials: JA
authors.lastname: Kanis
authors.affiliation: Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Kaufman
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.affiliation: Department of Rheumatology, VU University Medical Hospital, Amsterdam, The Netherlands.
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.affiliation: Centre for Metabolic Bone Diseases, Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
authors.forename: Eugene
authors.initials: E
authors.lastname: McCloskey
authors.affiliation: Immunogenomics and Inflammation Research Unit, Department of Immunology and Rheumatology, University of Lyon 1, Lyon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Miossec
authors.affiliation: , Bonn, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Reiter
authors.affiliation: West German Osteoporosis Center (WOC), University of Cologne, Leverkusen, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Ringe
authors.affiliation: Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Rizzoli
authors.affiliation: Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham, AL, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Saag
authors.affiliation: Department of Public Health, Epidemiology and Health Economics, University of Liege, Liège, Belgium.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Reginster
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D032921:Consensus; D005060:Europe; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D010024:Osteoporosis / Q000209:etiology / Q000517:prevention & control; D012216:Rheumatic Diseases / Q000188:drug therapy*; D018570:Risk Assessment
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids
keywords: Cohort studies; Glucocorticoids; Inflammation; Osteoporosis; Rheumatic diseases; Rheumatoid arthritis