PMID- 37745141 OWN - NLM STAT- Publisher LR - 20230926 IS - 0034-6233 (Print) IS - 2084-9834 (Electronic) IS - 0034-6233 (Linking) VI - 61 IP - 4 DP - 2023 TI - The dichotomy of glucocorticosteroid treatment in immune-inflammatory rheumatic diseases: an evidence-based perspective and insights from clinical practice. PG - 283-293 LID - 10.5114/reum/170845 [doi] AB - OBJECTIVES: Glucocorticosteroids (GCs) are the most used anti-inflammatory and immunosuppressive drugs due to their effectiveness in managing pain and disease modification in many immune-inflammatory rheumatic diseases (IRDs). However, their use is limited because of adverse effects (AEs). MATERIAL AND METHODS: The authors analyzed recent studies, including randomized controlled trials (RCTs), observational, translational studies and systematic reviews, providing an in-depth viewpoint on the benefits and drawbacks of GC use in rheumatology. RESULTS: Glucocorticosteroids are essential in managing life-threatening autoimmune diseases and a cornerstone in many IRDs given their swift onset of action, necessary in flares. Several RCTs and meta-analyses have demonstrated that when administered over a long time and on a low-dose basis, GC can slow the radiographic progression in early rheumatoid arthritis (RA) patients by at least 50%, satisfying the conventional definition of a disease-modifying anti-rheumatic drug (DMARD). In the context of RA treatment, the use of modified-release prednisone formulations at night may offer the option of respecting circadian rhythms of both inflammatory response and HPA activation, thereby enabling low-dose GC administration to mitigate nocturnal inflammation and prolonged morning fatigue and joint stiffness. Long-term GC use should be individualized based on patient characteristics and minimized due to their potential AEs. Their chronic use, especially at medium/high dosages, might cause irreversible organ damage due to the burden of metabolic systemic effects and increased risk of infections. Many international guidelines recommend tapering/withdrawal of GCs in sustained remission. Treat-to-target (T2T) strategies are critical in setting targets for disease activity and reducing/discontinuing GCs once control is achieved. CONCLUSIONS: Glucocorticosteroids' use in treating IRDs should be judicious, focused on minimizing use, tapering and discontinuing treatment, when possible, to improve long-term safety. Glucocorticosteroids remain part of many therapeutic regimens, particularly at low doses, and elderly RA patients, especially with associated chronic comorbidities, may benefit from long-term low-dose GC treatment. A personalized GC therapy is essential for optimal long-term outcomes. CI - Copyright: (c) 2023 Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. FAU - Hysa, Elvis AU - Hysa E AUID- ORCID: 0000-0002-6970-0983 AD - Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy. AD - IRCCS - San Martino Polyclinic Hospital, Genova, Italy. FAU - Vojinovic, Tamara AU - Vojinovic T AUID- ORCID: 0000-0003-1720-1151 AD - Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy. AD - IRCCS - San Martino Polyclinic Hospital, Genova, Italy. FAU - Gotelli, Emanuele AU - Gotelli E AUID- ORCID: 0000-0002-4732-0306 AD - Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy. AD - IRCCS - San Martino Polyclinic Hospital, Genova, Italy. FAU - Alessandri, Elisa AU - Alessandri E AUID- ORCID: 0009-0008-0454-8512 AD - Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy. AD - IRCCS - San Martino Polyclinic Hospital, Genova, Italy. FAU - Pizzorni, Carmen AU - Pizzorni C AD - Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy. AD - IRCCS - San Martino Polyclinic Hospital, Genova, Italy. FAU - Paolino, Sabrina AU - Paolino S AUID- ORCID: 0000-0001-9269-5089 AD - Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy. AD - IRCCS - San Martino Polyclinic Hospital, Genova, Italy. FAU - Sulli, Alberto AU - Sulli A AUID- ORCID: 0000-0003-3674-4880 AD - Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy. AD - IRCCS - San Martino Polyclinic Hospital, Genova, Italy. FAU - Smith, Vanessa AU - Smith V AD - Department of Internal Medicine, Department of Rheumatology, University Hospital Ghent, Belgium. AD - Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium. FAU - Cutolo, Maurizio AU - Cutolo M AD - Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy. AD - IRCCS - San Martino Polyclinic Hospital, Genova, Italy. LA - eng PT - Journal Article PT - Review DEP - 20230831 PL - Poland TA - Reumatologia JT - Reumatologia JID - 20130190R PMC - PMC10515127 OTO - NOTNLM OT - immune-mediated rheumatic diseases OT - overview on glucocorticosteroids OT - quality of life COIS- The authors declare no conflict of interest. EDAT- 2023/09/25 06:42 MHDA- 2023/09/25 06:42 PMCR- 2023/01/01 CRDT- 2023/09/25 04:54 PHST- 2023/04/16 00:00 [received] PHST- 2023/08/08 00:00 [accepted] PHST- 2023/09/25 06:42 [medline] PHST- 2023/09/25 06:42 [pubmed] PHST- 2023/09/25 04:54 [entrez] PHST- 2023/01/01 00:00 [pmc-release] AID - 170845 [pii] AID - 10.5114/reum/170845 [doi] PST - ppublish SO - Reumatologia. 2023;61(4):283-293. doi: 10.5114/reum/170845. Epub 2023 Aug 31.