Glucocorticosteroids in the management of rheumatoid arthritis

Glucocorticosteroids are used frequently in the management of patients with rheumatoid arthritis. Data supporting their efficacy and safety are still meagre. Glucocorticosteroids may be used systemically with different routes of administration (oral, i.m. and i.v.), in different doses and for differ ent periods of time. The effectiveness of glucocorticosteroids in reducing inflammation in the short term has been shown for oral treatment in a dose of 7.5 mg prednisolone daily or more, for i.m. pulses (120 mg methylprednis olone every 4 weeks) and for i.v. methylprednisolone pulses. For longer per iods of treatment, the evidence suggesting effectiveness of low-dose oral g lucocorticosteroids is more limited. Some data suggest that different regim ens of glucocorticosteroids may retard the development of erosions in patie nts with rheumatoid arthritis. The toxicity of short-term treatment is rela tively low. For long-term treatment, the development of osteoporosis is a s erious problem. Concomitant therapy with either calcitriol or bisphosphonat es may reduce this risk.