Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
Ann Rheum Dis. 2012 Nov;71(11):1761-4. doi: 10.1136/annrheumdis-2012-202021. Epub 2012 Jul 31.
Glucocorticoids are one of the most frequently prescribed therapies in rheumatology, a reflection of their effectiveness as a powerful anti-inflammatory drug. Glucocorticoids are also, however, associated with a wide range of adverse events, particularly at higher doses. To make appropriate decisions, doctors and patients need to weigh these benefits against the potential harms. This article describes the many uncertainties which make informed prescribing difficult. We lack knowledge, for example, on the magnitude of risk, the relationship to dose and duration, and what happens to risk on stopping therapy. Beyond safety, we describe how patients may lack understanding of the nature of the benefits and harms, and how to incorporate value judgements which are crucial to the decision making process. We conclude by exploring how future research might fill these knowledge gaps to enable a better informed decision process.
糖皮质激素是风湿病学中最常开的药物之一，这反映了它们作为一种强大的抗炎药物的有效性。然而，糖皮质激素也与广泛的不良反应相关，特别是在较高剂量时。为了做出适当的决策，医生和患者需要权衡这些益处与潜在危害。本文描述了许多不确定性，这些不确定性使得知情处方变得困难。例如，我们缺乏关于风险程度、与剂量和持续时间的关系以及停止治疗后风险会如何变化的知识。除了安全性，我们还描述了患者可能对益处和危害的性质缺乏了解，以及如何纳入对决策过程至关重要的价值判断。最后，我们探讨了未来的研究如何填补这些知识空白，以实现更好的知情决策过程。
