Corticosteroids in the treatment of rheumatologic diseases

Over the past year, a number of important advances have been made in understanding the pathobiology and clinical utility of corticosteroid agents for rheumatic disease patients. Unfortunately, the new information did not always confirm our preconceived notions. Pulse or intermittent high-dose steroid administration for rheumatoid arthritis as yet does not have a clear role. Observational analyses of populations of rheumatoid arthritis subjects, although based on data from the most severely ill patients, turn us away from using prednisone as background therapy in rheumatoid arthritis. Bone loss may be rapid and profound in rheumatoid arthritis patients in spite of clinical improvement from what are believed to be "acceptable" low doses of prednisone, and high-dose corticosteroid treatment of giant cell arteritis may be worse than the disease itself. Several reviews point to thoughtful strategies for the prevention of corticosteroid side effects. It is clear that new dosing arrangements need to be created and studied.