Corticosteroids in the treatment of rheumatologic diseases

Studies and reviews published over the past year have emphasized the benefits, risks, and risk-benefit ratios of corticosteroid use in the chronic rheumatic diseases. British researchers have repeated and confirmed studies done over 30 years ago that revealed a reduction in the new erosion rate in corticosteroid-treated rheumatoid arthritis patients with early-onset disease. Is 7.5 mg/d of prednisolone as safe as it is effective? The accuracy of new techniques for measuring bone density now allows us to assess the small differences that may result from "low" doses of corticosteroids as well as to address the confounding issues resulting from disease activity and severity variables. Recent studies confirm the deleterious effect on bone mineral density resulting from doses as low as 5 mg/d. Because we now have a better idea of the benefits as well as the risks, it has been strongly suggested that risk-benefit ratios be estimated and potentially enhanced by prophylactic strategies for bone preservation. Proof for the benefit of these strategies as well as for their ability to reduce fracture rates awaits another review cycle.