Effects of long-term glucocorticoid therapy in rheumatoid arthritis

Radiographic erosions develop in about two thirds of patients with rheumato id arthritis (RA). Gluco corticoids offer rapid and substantial control of the symptoms of inflammation in the short and medium term. Data are reviewe d which suggest that this benefit may not last into the longer term (more t han 1 year). However, recent studies provide unequivocal evidence that join t destruction can be halted in this disease. Also, by separating the short- term anti-inflammatory effect from a more prolonged suppression of joint de struction, these studies have shed light on the underlying pathological pro cesses. The evidence from these therapeutic clinical trials strengthens the view that inflammation and joint destruction are parallel processes, loose ly linked by the underlying cause of RA, but progressing to some extent ind ependently. It is intriguing to speculate that different effects of glucoco rticoids might relate to their different modes of action outlined elsewhere in this symposium.