title: It hasn't gone away: the problem of glucocorticoid use in lupus remains.
abstract: The treatment of SLE remains complex, and management is constrained by a lack of safe, effective, targeted therapies. Physicians, also, are constrained by a lack of evidence-based approaches with existing agents, including glucocorticoids, utilized in the majority of patients. While Cushingoid side effects of glucocorticoids are widely recognized, emerging literature now suggests that glucocorticoid use actually contributes to harmful outcomes in SLE, over and above these effects. These studies provide a compelling case for a re-evaluation of the long-term use of glucocorticoids in SLE, focusing on minimizing glucocorticoid exposure as part of the strategy to improve long-term outcomes. In this article, we review the evidence for the harmful effects of glucocorticoids in SLE, and propose therapeutic options that reduce reliance on glucocorticoids. We propose that it is time for the lupus community to have a louder conversation about glucocorticoid use, and for any residual complacency about their risk-benefit ratio to be banished.
authors.affiliation: School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia.
authors.forename: Diane
authors.initials: D
authors.lastname: Apostolopoulos
authors.affiliation: School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia.
authors.forename: Eric F
authors.initials: EF
authors.lastname: Morand
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D002386:Cataract / Q000139:chemically induced; D003480:Cushing Syndrome / Q000139:chemically induced*; D003920:Diabetes Mellitus / Q000139:chemically induced; D018450:Disease Progression; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced / Q000188:drug therapy* / Q000503:physiopathology; D009173:Mycophenolic Acid / Q000627:therapeutic use; D010020:Osteonecrosis / Q000139:chemically induced; D058866:Osteoporotic Fractures / Q000139:chemically induced
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D006886:Hydroxychloroquine; C511911:belimumab; D009173:Mycophenolic Acid; D001379:Azathioprine
keywords: SLE; corticosteroids; damage; glucocorticoids; lupus; outcomes; prednisolone; prednisone; steroids; systemic lupus erythematosus