[Safety aspects of the treatment with glucocorticoids for rheumatoid arthritis]

Glucocorticoids (GC) are still the recommended initial treatment for rheumatoid arthritis, although the treatment should be temporary and confined to the administration of low doses. The complex mechanism of action is accompanied by side effects that particularly occur in long-term treatment exceeding 5 mg prednisolone per day. In this dosage range they promote osteoporosis, diabetes and hyperglycemia as well as cardiovascular events and infections, thereby contributing to an excess mortality. The risks of GC treatment are dependent on patient-related parameters, such as age, comorbidity and additional medication. A negative influence of very low steroid doses on overall survival is possibly due to high cumulative steroid doses; however, the data in this respect are contradictory. Recently, a validated index was developed to monitor GC-related toxicity. In the future, this index should help to describe the advantages of steroid-sparing treatment strategies. In the future, more selectively acting substances could achieve an uncoupling of desired and adverse effects.