Glucocorticoids in the treatment of early and late RA

摘要: A little GC, like a glass of wine, may benefit many people, whereas high dose bottle is harmful to all At the 2003 meeting American College Rheumatology (ACR) debate on advantages and disadvantages glucocorticoids (GCs) in treatment early late rheumatoid arthritis (RA) was held, with some authors putting case for, others against, such (presentations now available online: http://www.rheumatology.org). Some new data emerged, this paper summarises arguments existing data. Hench awarded Nobel prize 1950 for discovery GCs their effect established RA. However, subsequently disillusionment set in, caused by rapid appearance unacceptable side effects long term treatment, loss efficacy at lower dosing. The dogma became that systemic only temporary symptomatic relief, led habituation danger ever increasing doses necessary maintain effect, chronic universally effects. Therefore, often considered as last resort. An associated idea RA most cases benign disease, which, although incurable, significant disability minority cases. combination these ideas rheumatologists limit traditional schemes emphasised rest, lifestyle adjustment, non-steroidal anti-inflammatory drugs (NSAIDs), spa treatment. In unresponsive antirheumatic intramuscular gold were advised. paradigm shift initiated Wilske Healey, who argued pyramid should be inverted aggressive started early.1 This based outcome studies recorded dismal prognosis patients when followed up …