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All systemic steroid guidelines for RA offer little guidance.

Every current guideline and consensus statement regarding systemic glucocorticoid therapy in rheumatoid arthritis fall short of offering clinicians practical, evidence-based guidance, according to a systematic review of all 15 such documents published in 2011-2015 in English, French, German, and Spanish.

Fewer than half of the existing guidelines explicitly recommend these agents. Even fewer specify the optimal treatment duration or dose.

The reason? Lack of good-quality evidence, said Yannick Palmowski of the department of rheumatology and clinical immunology at Charite University Medicine, Berlin, and his associates. Their report, published in Arthritis Care & Research, does not address intra-articular administration of glucocorticoids. The 15 sets of guidelines were developed by 13 different rheumatology associations and networks across five continents (Arthritis Care Res. 2016 Dec 28. doi: 10.1002/acr.23185). In this comprehensive review of 3,742 relevant publications, there was general agreement that initial treatment should center on disease-modifying antirheumatic drugs (DMARDs) plus systemic glucocorticoids. If remission, or at least reduced disease activity with preserved function, doesn't occur within 3-6 months, another synthetic or a biologic DM ARD should be tried, with or without concomitant glucocorticoids. But none of the guidelines adequately address the timing or frequency of use, either in early RA or in established disease.

This study was sponsored by the Glucocorticoid Low-Dose Outcome in RA Project of the European Commission's Horizon 2020 Initiative.



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Title Annotation:RHEUMATOLOGY
Author:Moon, Mary Ann
Publication:Family Practice News
Date:Feb 1, 2017
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