Thiele K, Buttgereit F, Huscher D, Zink A
Deutsches Rheuma-Forschungszentrum Berlin, Forschungsbereich Epidemiologie, 10117 Berlin, Germany.
Z Rheumatol. 2005 Apr;64(3):149-54. doi: 10.1007/s00393-005-0719-3.
Systemic GCs are among the most important therapeutic options in modern rheumatology. Due to their fast clinical effects and their high anti-inflammatory potential, they are indispensable in a large number of cases. This applies despite the well-known spectrum of adverse events and despite limited evidence from randomized clinical trials. In this situation, the results of observational studies gain additional importance. They provide information on therapeutic decisions of rheumatologists concerning GC therapy and their combination with other drugs as well as concerning the prevention of adverse events such as GC induced osteoporosis. The data gathered in the national database of the German Collaborative Arthritis Centers show that at the time of documentation 60% of all RA patients were under therapy with GCs, 85% of these were treated with a dosage of up to 7.5 mg/d. GCs are especially frequently used in combination with new or highly potent DMARDs. This underlines that rheumatologists take activity and severity into account in deciding both about GCs and DMARDs. However, there is high practice variation regarding the frequency of GC use among the rheumatological facilities which demonstrates the lack of good evidence.Rheumatologists are aware of various patient risks when prescribing GCs and adapt their therapies to these risks. Two thirds of all patients under GCs were receiving therapy for the prevention or treatment of osteoporosis at documentation, high risk groups such as women over 50 even more frequently. The data emphasize the high importance of GCs in modern rheumatology.
全身性糖皮质激素（GCs）是现代风湿病学中最重要的治疗选择之一。由于其快速的临床疗效和强大的抗炎潜力，在许多情况下它们不可或缺。尽管存在众所周知的一系列不良事件，且随机临床试验的证据有限，但情况依然如此。在这种情况下，观察性研究的结果变得更加重要。它们提供了有关风湿病学家在GC治疗及其与其他药物联合使用方面的治疗决策信息，以及有关预防不良事件（如GC诱导的骨质疏松症）的信息。德国协作性关节炎中心国家数据库收集的数据显示，在记录时，所有类风湿关节炎（RA）患者中有60%正在接受GC治疗，其中85%的患者接受的剂量高达7.5毫克/天。GCs尤其经常与新型或强效的改善病情抗风湿药（DMARDs）联合使用。这突出表明，风湿病学家在决定使用GCs和DMARDs时会考虑疾病活动度和严重程度。然而，在各风湿病治疗机构中，GC使用频率存在很大差异，这表明缺乏充分的证据。风湿病学家在开具GCs处方时意识到了各种患者风险，并根据这些风险调整治疗方案。在记录时，所有接受GCs治疗的患者中有三分之二正在接受预防或治疗骨质疏松症的治疗，50岁以上女性等高风险群体的治疗频率更高。这些数据强调了GCs在现代风湿病学中的高度重要性。
