Bacher Corey, Narayanswami Pushpa, Bromberg Mark, Buttgereit Frank, Dodig Dubravka, Flanagan Eoin P, Gottlieb Chloe, Marshall John K, McCoy Rozalina G, Mitchell Sara, Tosh Pritish K, Sinha Partha S, Laughlin Ruple S, Kassardjian Charles D
Division of Neurology, Department of Medicine, Scarborough Health Network and University of Toronto, Toronto, Ontario, Canada.
Beth Israel Deaconess Medical Center/Harvard Medical School (P.N.), Boston, Massachusetts, USA.
Muscle Nerve. 2025 Mar;71(3):309-316. doi: 10.1002/mus.28328. Epub 2025 Jan 3.
INTRODUCTION/AIMS: Glucocorticoid (GC)-related adverse reactions and risks are commonly seen during the treatment of immune-mediated and inflammatory neuromuscular disorders. There is wide variation in the management of associated complications. The aim of this study is to develop international consensus guidance on the management of GC-related complications in neuromuscular disorders.
Through the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM), an international task force of 15 experts was convened to develop clinical guidance for the management of GC-related complications in neuromuscular patients. The RAND/UCLA appropriateness method (RAM) was used to develop consensus guidance statements. Initial guidance statements were crafted after a thorough literature review and were modified after anonymous panel input, with up to three rounds of voting via email to achieve consensus.
Statements were developed and achieved consensus for general care, monitoring of patients while on GC, osteoporosis prevention, vaccinations, infection screening, and Pneumocystis jiroveci pneumonia prophylaxis. A multidisciplinary approach to the management of GC-related complications was emphasized.
These formal consensus statements provide guidance to clinicians who use GC in the treatment of neuromuscular diseases regarding prevention and management of the more common associated adverse events and risks that arise with long and short-term GC use and serve as a springboard for investigation and updates.
引言/目的：在免疫介导性和炎性神经肌肉疾病的治疗过程中，糖皮质激素（GC）相关的不良反应和风险较为常见。相关并发症的管理存在很大差异。本研究的目的是就神经肌肉疾病中GC相关并发症的管理制定国际共识指南。
通过美国神经肌肉与电诊断医学协会（AANEM），召集了一个由15名专家组成的国际特别工作组，以制定针对神经肌肉疾病患者GC相关并发症管理的临床指南。采用兰德/加州大学洛杉矶分校适宜性方法（RAM）来制定共识指导声明。初步指导声明是在全面的文献综述后制定的，并在匿名专家小组提出意见后进行修改，通过电子邮件进行多达三轮投票以达成共识。
针对一般护理、GC治疗期间患者的监测、骨质疏松症预防、疫苗接种、感染筛查以及卡氏肺孢子虫肺炎预防等方面制定了声明并达成了共识。强调了采用多学科方法管理GC相关并发症。
这些正式的共识声明为在神经肌肉疾病治疗中使用GC的临床医生提供了指导，涉及预防和管理长期及短期使用GC时出现的较常见相关不良事件和风险，并为进一步研究和更新提供了基础。
