[Rheumatoid arthritis: what role do oral glucocorticoids play in 2026?]

For over 75 years, oral glucocorticoids (OGCs) have been used to treat rheumatoid arthritis (RA). They have shown benefits on disease activity and radiological progression. However, their use is associated with an increased risk of cardiovascular disease and osteoporosis, correlated to treatment duration and dosage. Long-term use is therefore not recommended in RA. Short-term use when starting an immunosuppressive agent remains debated. Although OGCs provide rapid efficacy, they carry a higher risk of infection, even at low doses. Similar efficacy can be achieved after 6 months with immunosuppressive and biologic agents. Moreover, tapering is challenging, as 30 to 50% of patients fail to discontinue OGCs after 2 years in routine practice.