Efficacy and safety of glucocorticoids in rheumatoid arthritis: Systematic literature review
Reumatol Clin (Engl Ed). 2020 May-Jun;16(3):222-228.
doi: 10.1016/j.reuma.2018.06.007.
Epub 2018 Jul 26.
[Article in
English,
Spanish]
Authors
Raimon Sanmartí
1
, Jesús Tornero
2
, Javier Narváez
3
, Alejandro Muñoz
4
, Elena Garmendia
5
, Ana M Ortiz
6
, Miguel Angel Abad
7
, Patricia Moya
8
, María Lourdes Mateo
9
, Delia Reina
10
, Juan Salvatierra-Ossorio
11
, Sergio Rodriguez
12
, Natalia Palmou-Fontana
13
, Ana Ruibal-Escribano
14
, Jaime Calvo-Alén
15
Affiliations
- 1 Servicio de Reumatología, Hospital Clínic, Barcelona, España. Electronic address: SANMARTI@clinic.cat.
- 2 Servicio de Reumatología, Departamento de Medicina y Especialidades Médicas, Hospital Universitario de Guadalajara, Universidad de Alcalá, Guadalajara, España.
- 3 Servicio de Reumatología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
- 4 Servicio de Reumatología, Hospital Universitario Virgen del Rocío, Sevilla, España.
- 5 Servicio de Reumatología, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España.
- 6 Servicio de Reumatología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, España.
- 7 Servicio de Reumatología, Hospital Virgen del Puerto, Plasencia, Cáceres, España.
- 8 Sección de Reumatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
- 9 Servicio de Reumatología, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
- 10 Servicio de Reumatología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España.
- 11 Servicio de Reumatología, Complejo Hospitalario Universitario de Granada, Granada, España.
- 12 Servicio de Reumatología, Hospital Universitario Virgen de Valme, Sevilla, España.
- 13 Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Cantabria, España.
- 14 Sección de Reumatología, Hospital Alfredo Espinosa, Urduliz, Vizcaya, España.
- 15 Servicio de Reumatología, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España.
Abstract
Objectives:
1) To systematically and critically review the evidence on the characteristics, efficacy and safety of glucocorticoids (CS) in rheumatoid arthritis (RA); 2) to generate practical recommendations.
Methods:
A systematic literature review was performed through a sensitive bibliographic search strategy in Medline, Embase and the Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of CS in patients with RA. Two reviewers performed the first selection by title and abstract. Then 10 reviewers selected the studies after a detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. In a nominal group meeting, based on the results of the systematic literature review, related recommendations were reached by consensus.
Results:
A total of 47 articles were finally included. CS in combination with disease-modifying antirheumatic drugs help control disease activity and inhibit radiographic progression, especially in the short-to-medium term and in early RA. CS can also improve function and relieve pain. Different types and routes of administration are effective, but there is no standardized scheme (initial dose, tapering and duration of treatment) that is superior to others. Adverse events when using CS are very frequent and are dose-dependent and variable severity, although most are mild. Seven recommendations were generated on the use and risk management of CS.
Conclusions:
These recommendations aim to resolve some common clinical questions and aid in decision-making for CS use in RA.
Keywords:
Artritis reumatoide; Glucocorticoides; Glucocorticoids; Revisión sistemática de la literatura; Rheumatoid arthritis; Systematic literature review.
Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.
MeSH terms
-
Arthritis, Rheumatoid / drug therapy*
-
Glucocorticoids / adverse effects
-
Glucocorticoids / therapeutic use*
-
Humans
-
Treatment Outcome