Glucocorticoid treatment in spondyloarthritis

Spondyloarthritides (SpA) are chronic inflammatory rheumatic diseases that usually affect the axial skeleton and may involve entheses and peripheral joints. The main subtypes are ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Other subtypes are reactive arthritis, arthritis associated with chronic inflammatory bowel diseases and undifferentiated axial and peripheral spondyloarthritis. Although SpA were regarded as variants of rheumatoid arthritis (RA) until the 1970s, it is now well established that the pathogenesis of SpA is quite different from that of RA. There is a lack of good clinical studies on glucocorticoid therapy in the SpA. While there is no reasonable doubt that intraarticular local therapies in SpA are as effective as in RA and other forms of arthritis, the evidence for a systemic use is at best marginal. While very high doses may be effective in some patients with AS, the possible value of low-dose corticosteroid therapy in patients with PsA has never been well addressed, with respect to either clinical efficacy or inhibition of radiographic progression. Future studies are needed to clarify this important issue for usual patient care.