Irisweg 5 , D - 40489 Düsseldorf , Germany +49 203 740441 ; +49 203 7384800 ;
Expert Opin Pharmacother. 2014 Aug;15(11):1575-83. doi: 10.1517/14656566.2014.922955. Epub 2014 May 26.
In spite of its broad use since 1950 the role of low-dose glucocorticoids (GCs) (up to 7.5 mg/day prednisone) in the treatment of rheumatoid arthritis is still controversial.
Publications comparing disease-modifying anti-rheumatic drugs (DMARD) plus prednisolone with DMARD monotherapy were reviewed. Most studies reported greater clinical improvement and greater inhibition of damage progression in the prednisone group. These advantages had vanished after 6 - 12 months in most studies.
Several limitations of the studies are discussed. Often the advantage of GC treatment was not clinically important. Long-term data are needed to evaluate the real benefit of GC treatment in relation to its toxicity. Knowing the potential toxicity 'bridging' GC treatment should be reserved for patients at high risk of damage progression; a reliable method to identify these patients is needed. The toxicity of low-dose GC treatment is often played down. The reporting is incomplete. The increased mortality ratio with GC treatment is rarely mentioned. High cumulative doses are a risk factor. A more comprehensive set of toxicity items is urgently needed. Problems of GC treatment are the 'drug addiction' of the patient and the difficulty to reduce or withdraw prednisone.
尽管自 1950 年以来广泛使用，但小剂量糖皮质激素（GC）（每天 7.5 毫克泼尼松）在类风湿关节炎治疗中的作用仍存在争议。
对比较疾病修正抗风湿药物（DMARD）加泼尼松与 DMARD 单药治疗的出版物进行了回顾。大多数研究报告称，泼尼松组的临床改善更大，损伤进展的抑制作用更大。在大多数研究中，6-12 个月后，这些优势就消失了。
讨论了研究的几个局限性。GC 治疗的优势通常在临床上并不重要。需要长期数据来评估 GC 治疗与毒性相关的实际益处。为了了解 GC 治疗对损伤进展的潜在毒性“桥接”作用，应该为高损伤进展风险的患者保留这种治疗；需要一种可靠的方法来识别这些患者。GC 治疗的毒性往往被淡化了。报告不完整。GC 治疗导致的死亡率增加很少被提及。高累积剂量是一个危险因素。迫切需要更全面的毒性指标集。GC 治疗存在的问题是患者的“药物成瘾”和减少或停用泼尼松的困难。
