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.

Autor:	Strehl C; Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany., Bijlsma JW; Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, the Netherlands Amsterdam Rheumatology& Immunology Center, VU University Medical Center, Amsterdam, the Netherlands., de Wit M; Medical Humanities, VU Medical Centre, Amsterdam, the Netherlands., Boers M; Amsterdam Rheumatology& Immunology Center, VU University Medical Center, Amsterdam, the Netherlands Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, the Netherlands., Caeyers N; Patient Research Partner, Mol, Belgium., Cutolo M; Department of Internal Medicine, Research Laboratory & Academic Division of Clinical Rheumatology, University of Genoa, Genova, Italy., Dasgupta B; Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK., Dixon WG; Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester, UK., Geenen R; Department of Clinical & Health Psychology, Utrecht University, Utrecht, the Netherlands., Huizinga TW; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands., Kent A; Salisbury Foundation Trust NHS Hospital, Wiltshire, UK., de Thurah AL; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark., Listing J; Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany., Mariette X; Department of Rheumatology, Assistance Publique-Hopitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France Université Paris-Sud; INSERM U1184, Le Kremlin Bicêtre, France., Ray DW; Faculty of Medical and Health Sciences, University of Manchester, Manchester, UK., Scherer HU; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands., Seror R; Department of Rheumatology, Assistance Publique-Hopitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France Université Paris-Sud; INSERM U1184, Le Kremlin Bicêtre, France., Spies CM; Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany., Tarp S; Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark., Wiek D; Deutsche Reuma-Liga, Bonn, Germany., Winthrop KL; Divisions of Infectious Diseases, Oregon Health & Science University, Portland, USA., Buttgereit F; Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany.
Jazyk:	angličtina
Zdroj:	Annals of the rheumatic diseases [Ann Rheum Dis] 2016 Jun; Vol. 75 (6), pp. 952-7. Date of Electronic Publication: 2016 Mar 01.
DOI:	10.1136/annrheumdis-2015-208916
Abstrakt:	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. (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
Databáze:	MEDLINE
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