Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task force

医学 强的松 危害 不利影响 糖皮质激素 风湿病 剂量 重症监护医学 内科学 心理学 社会心理学
作者
Cindy Strehl,Johannes W J Bijlsma,Maarten de Wit,Maarten Boers,N. Caeyers,Maurizio Cutolo,Bhaskar Dasgupta,William G Dixon,Rinie Geenen,T. Huizinga,Alison Kent,Annette de Thurah,Joachim Listing,Xavier Mariette,David Ray,Hans Ulrich Scherer,Raphaèle Séror,Claudia Spies,Simon Tarp,Dieter Wiek,Kevin Winthrop,Frank Buttgereit
出处
期刊:Annals of the Rheumatic Diseases [BMJ]
卷期号:75 (6): 952-957 被引量:275
标识
DOI:10.1136/annrheumdis-2015-208916
摘要

There is convincing evidence for the known and unambiguously accepted beneficial effects of glucocorticoids at low dosages. However, the implementation of existing recommendations and guidelines on the management of glucocorticoid therapy in rheumatic diseases is lagging behind. As a first step to improve implementation, we aimed at defining conditions under which long-term glucocorticoid therapy may have an acceptably low level of harm. A multidisciplinary European League Against Rheumatism task force group of experts including patients with rheumatic diseases was assembled. After a systematic literature search, breakout groups critically reviewed the evidence on the four most worrisome adverse effects of glucocorticoid therapy (osteoporosis, hyperglycaemia/diabetes mellitus, cardiovascular diseases and infections) and presented their results to the other group members following a structured questionnaire for final discussion and consensus finding. Robust evidence on the risk of harm of long-term glucocorticoid therapy was often lacking since relevant study results were often either missing, contradictory or carried a high risk of bias. The group agreed that the risk of harm is low for the majority of patients at long-term dosages of ≤5 mg prednisone equivalent per day, whereas at dosages of >10 mg/day the risk of harm is elevated. At dosages between >5 and ≤10 mg/day, patient-specific characteristics (protective and risk factors) determine the risk of harm. The level of harm of glucocorticoids depends on both dose and patient-specific parameters. General and glucocorticoid-associated risk factors and protective factors such as a healthy lifestyle should be taken into account when evaluating the actual and future risk.
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