Pharmacology of glucocorticoids in rheumatoid arthritis

Glucocorticoids (GCs) provide one of the most effective treatments for rheumatoid arthritis (RA); however, their long-term use is marred by undesired side effects. Increased understanding of the mechanisms of glucocorticoid action enables the development of novel drugs, such as SEGRAs or liposomal glucococorticoids, trying to improve their benefit/risk ratio. But also trying to optimise the use of conventional glucocorticoids is a sensible approach. One example is a new modified release prednisone tablet formulation that has been recently shown to be clinically and significantly better than the conventional immediate-release preparation with respect to reducing morning stiffness of the joints. The 'old spear' can also be sharpened by collecting clear-cut evidence on the efficacy and safety of conventional glucocorticoid therapy and deriving from that reliable evidence-based recommendations. This short review summarises the current knowledge in this regard, with particular emphasis on recently published articles.