Introduction

Glucocorticoids (GCs) are key actors in RA management, despite the increasing number of available drugs. In fact, due to their efficacy and safety, the combination therapy between GCs and conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) is still recommended in the early phase of RA treatment, because improving the long-term results.

Areas covered

In this paper, we reviewed the role of GCs in RA management, focusing on mechanisms of action as well as the benefit/risk ratio of GCs and newer therapeutic formulations. Furthermore, we analyzed GCs DMARDs proprieties on disease activity and their long-term effects on radiographic damage. We designed a narrative review aimed to provide an overview concerning GCs in RA management.

Expert opinion

A large amount of evidence supports the use of GCs in RA, especially in the earliest phases of the disease. Besides GCs symptomatic effects due to their strong anti-inflammatory effects, data from several randomized clinical trials have shown a substantial benefit of low-dose GCs in inhibiting the radiographic damage, thus highlighting GCs DMARDs properties. Besides their recognized role in the treatment of early RA, systematic monitoring of adverse events should be recommended to minimize GCs toxicity.

中文翻译：

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类风湿关节炎中的糖皮质激素：治疗策略中的沉默伴侣。

介绍

尽管可用药物的数量不断增加，但糖皮质激素 (GC) 是 RA 管理的关键因素。事实上，由于其疗效和安全性，GCs 与常规合成改善疾病抗风湿药（csDMARDs）的联合治疗仍被推荐用于 RA 治疗的早期阶段，因为可以改善长期效果。

涵盖的领域

在本文中，我们回顾了 GCs 在 RA 管理中的作用，重点关注作用机制以及 GCs 和新治疗制剂的效益/风险比。此外，我们分析了 GCs DMARDs 对疾病活动的特性及其对放射损伤的长期影响。我们设计了一个叙述性审查，旨在提供有关 RA 管理中 GC 的概述。

专家意见

大量证据支持在 RA 中使用 GC，尤其是在疾病的早期阶段。除了 GCs 由于其强大的抗炎作用而产生的症状效应外，来自几项随机临床试验的数据表明，低剂量 GCs 在抑制放射照相损伤方面具有显着优势，从而突出了 GCs DMARDs 的特性。除了它们在早期 RA 治疗中的公认作用外，还应建议对不良事件进行系统监测，以尽量减少 GCs 毒性。