Adverse effects of low-dose glucocorticoids and DMARD therapy in patients with RA - A complex relationship?

Although low-dose glucocorticoids, in conjunction with DMARDs, are known to halt or severely retard the erosive destruction of joints in patients with early rheumatoid arthritis (RA), the potential adverse effects of low-dose glucocorticoids and the benefit:risk ratio of treatment are a concern for many clinicians. Malysheva and colleagues undertook a retrospective, open-label review of the incidence and severity of adverse effects associated with DMARD treatment with or without glucocorticoids in patients with RA. Their results suggest that low-dose glucocorticoids actually help to postpone the occurrence of adverse effects caused by most standard DMARDs, which, if translated into a delay before biologic agents were required, would provide a substantial cost saving. Unfortunately, an increased incidence of adverse reactions was noted for glucocorticoid-treated patients compared with those patients on monotherapy; however, the undesirable effects were mostly mild in nature. This study sheds new light on the relative risks and benefits of low-dose glucocorticoid therapy in RA and adds further weight to the arguments for its appropriate use in early disease.