title: Quantifying cutaneous adverse effects of systemic glucocorticoids in patients with rheumatoid arthritis: a cross-sectional cohort study.
abstract: OBJECTIVE
  EULAR guidelines state that adverse effects (AEs) of glucocorticoid (GC) therapy should be considered and discussed with the patient before treatment is initiated. However, reliable quantitative data, especially on cutaneous AEs of low-to-medium dose GCs are lacking. We performed a study assessing the occurrence of cutaneous AEs of GCs and its association with current and cumulative GC doses in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  In a cross-sectional study performed in 2 outpatient rheumatology centres, 381 RA patients were enrolled. They were classed into 4 groups, according their mean daily dose during the past 12 months: 0 mg (n=87), <5mg (n=108), 5-7.5 mg (n=130), and >7.5 mg (n=56) of prednisone equivalent. AEs of GC on the skin were assessed by physical examination using a predefined scoring system, and by patients' self-assessments. Data were analysed according GC dose categories and cumulative doses.
  
  
  RESULTS
  Cushingoid habitus, easy bruising, skin atrophy, and impaired wound healing as reported by patients occurred significantly more frequently in those using a GC the past 12 months, compared to those not using a GC. At physicians' assessments, only Cushingoid habitus and ecchymosis were more prevalent in GC users. The prevalence of these AEs was statistically significantly positively associated with current and cumulative GC dose. There was low occurrence of abnormal stretch marks, acne, perioral dermatitis, alopecia and hirsutism, which were not correlated with GC use.
  
  
  CONCLUSIONS
  Certain GC-associated cutaneous AEs are common in RA, but other AEs of GC occur infrequently at the low-to-medium GC doses used in RA.
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany.
authors.forename: Jonna
authors.initials: J
authors.lastname: Amann
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, the Netherlands.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Wessels
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Breitenfeldt
authors.affiliation: German Rheumatism Research Center Berlin, Epidemiology, Berlin, Germany.
authors.forename: Dörte
authors.initials: D
authors.lastname: Huscher
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, the Netherlands.
authors.forename: Johannes W J
authors.initials: JWJ
authors.lastname: Bijlsma
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, the Netherlands. j.w.g.jacobs@umcutrecht.nl.
authors.forename: Johannes W G
authors.initials: JWG
authors.lastname: Jacobs
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Buttgereit
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D001284:Atrophy; D003288:Contusions / Q000139:chemically induced / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000139:chemically induced / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D004438:Ecchymosis / Q000139:chemically induced / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012647:Self-Assessment; D012867:Skin / Q000187:drug effects* / Q000473:pathology; D012871:Skin Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
chemical_list: D005938:Glucocorticoids