The University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL, USA.
Clin Exp Rheumatol. 2011 Sep-Oct;29(5 Suppl 68):S104-12. Epub 2011 Oct 22.
Glucocorticoids (GC) remain the most commonly used agents for managing inflammatory rheumatic diseases. The adverse effects (AE) associated with high-dose GCs are well established, but there is a widespread misconception that AEs of high-dose GC therapy (>30 mg prednisone or equivalent daily) are similar in low-dose therapy (≤ 7.5mg prednisone equivalent a day). Although high-quality evidence on AEs of low-dose GC therapy is still lacking, risks and safety of low-dose GC therapy in rheumatic diseases are reviewed based on current evidence by category, including musculoskeletal, cardiovascular, infectious, gastrointestinal, neuropsychiatric, endocrine and metabolic, dermatologic, and ophthalmologic AEs. Recommendations concerning monitoring AEs with low-dose GC therapy are provided for each category of AEs on the basis of our literature review and clinical experience. There is emerging evidence that low-dose GCs are associated with a much lower level of AEs, which would allow their use over long periods in patients with rheumatic disease who gain clinical effectiveness and well-being from their use. Nonetheless, knowledge and understanding of AEs from low-dose GCs is vital to maximise benefits and minimise risks to patients.
糖皮质激素（GC）仍然是治疗炎症性风湿病最常用的药物。高剂量 GC 相关的不良反应（AE）已经得到充分证实，但人们普遍存在一种误解，即高剂量 GC 治疗（>30mg 泼尼松或等效日剂量）和低剂量治疗（≤7.5mg 泼尼松等效日剂量）的 AE 相似。尽管低剂量 GC 治疗 AE 的高质量证据仍然缺乏，但基于当前证据，按类别回顾了低剂量 GC 治疗在风湿病中的风险和安全性，包括肌肉骨骼、心血管、感染、胃肠道、神经精神、内分泌和代谢、皮肤和眼科 AE。根据我们的文献复习和临床经验，为每一类 AE 提供了关于监测低剂量 GC 治疗 AE 的建议。有新的证据表明，低剂量 GC 与较低水平的 AE 相关，这使得它们可以在从使用中获得临床疗效和获益的风湿病患者中长期使用。尽管如此，了解和认识低剂量 GC 的 AE 对于最大限度地提高患者的获益和降低风险至关重要。
