Morand Eric F
Centre for Inflammatory Disease, Monash University Department of Medicine/Monash Institute for Medical Research, Monash Medical Centre, Clayton, Melbourne, Victoria, Australia.
Curr Opin Rheumatol. 2007 May;19(3):302-7. doi: 10.1097/BOR.0b013e32805e87d0.
Glucocorticoids are used in the treatment of most rheumatic diseases, and are used chronically in up to 50% of cases of rheumatoid arthritis. The frequency of their use has in the past been incompletely supported by trial evidence of their benefit and by incomplete understanding of their mechanisms of action. The present review will examine significant recent publications relating to glucocorticoids of relevance to rheumatology
The basic science of glucocorticoid action has advanced considerably in the review period. Major advances include demonstration of the function of glucocorticoid-induced anti-inflammatory proteins such as mitogen-activated protein kinase phosphatase-1, expanded understanding of alternately spliced isoforms of the glucocorticoid receptor, and major steps in understanding factors regulating glucocorticoid sensitivity in disease. Clinical studies have also had major developments, most strikingly with the publication of two randomized prospective studies on the efficacy of glucocorticoids in preventing erosions in rheumatoid arthritis.
Despite over 50 years of glucocorticoid use in rheumatology, basic science and clinical studies continue to yield intriguing new data. The quest for therapeutic agents with the beneficial effects of glucocorticoids but lacking their harmful effects is aided by this progress.
糖皮质激素用于治疗大多数风湿性疾病，在高达50%的类风湿关节炎病例中被长期使用。过去，其使用频率并未完全得到有关其益处的试验证据以及对其作用机制的不完全理解的支持。本综述将审视近期发表的与风湿科相关的糖皮质激素的重要文献。
在本综述期间，糖皮质激素作用的基础科学有了显著进展。主要进展包括证实了糖皮质激素诱导的抗炎蛋白（如丝裂原活化蛋白激酶磷酸酶-1）的功能，对糖皮质激素受体可变剪接异构体的理解有所扩展，以及在了解疾病中调节糖皮质激素敏感性的因素方面取得的重大进展。临床研究也有了重大进展，最引人注目的是发表了两项关于糖皮质激素预防类风湿关节炎侵蚀疗效的随机前瞻性研究。
尽管糖皮质激素在风湿科已使用了50多年，但基础科学和临床研究仍不断产生有趣的新数据。这一进展有助于寻找具有糖皮质激素有益作用但无有害作用的治疗药物。
