Strand V, Simon L S
Division of Immunology and Rheumatology, Stanford University School of Medicine, 306 Ramona Road, Portola Valley, CA 94028, USA.
Clin Exp Rheumatol. 2003 Sep-Oct;21(5 Suppl 31):S186-90.
The use of glucocorticoid therapy in the treatment of rheumatoid arthritis [RA] remains controversial. There has been much data accumulated over the years describing both the risks and benefits of acute and chronic glucocorticoid therapy. Initially there was significant enthusiasm for this type of therapy given the extent of the anti-inflammatory effects. However, use was then modified as chronic therapy with higher doses was associated with frequent reports of important safety concerns. More recently low dose glucocorticoid therapy (e.g. < or = 5 mg prednisone per day) is being reconsidered in particular for patients with early disease. This paper will review the historical experience with higher dose therapy along with the evolving evidence of an improved benefit to risk ratio with the advent of concomitant therapies to minimize some of the more problematic adverse events associated with chronic use of even low dose glucocorticoid therapy. It is suggested that with appropriate monitoring and careful concomitant prophylactic therapy to prevent osteoporosis, adjunctive therapy using low dose glucocorticoids along with the appropriate disease modifying anti-rheumatic drug may be a reasonable treatment plan for select patients.
糖皮质激素疗法在类风湿关节炎（RA）治疗中的应用仍存在争议。多年来积累了大量数据，描述了急性和慢性糖皮质激素疗法的风险和益处。最初，鉴于其抗炎作用的程度，人们对这类疗法抱有极大热情。然而，随着高剂量长期治疗频繁出现重大安全问题的报道，其使用方式随后有所改变。最近，低剂量糖皮质激素疗法（如每天泼尼松≤5毫克）正被重新审视，尤其是对于早期疾病患者。本文将回顾高剂量疗法的历史经验，以及随着联合疗法的出现，其风险效益比得到改善的不断演变的证据，联合疗法可将与长期使用甚至低剂量糖皮质激素疗法相关的一些更棘手的不良事件降至最低。建议在适当监测和谨慎联合预防性治疗以预防骨质疏松的情况下，对于部分患者而言，低剂量糖皮质激素联合适当的改善病情抗风湿药物的辅助治疗可能是一个合理的治疗方案。
