Systemic glucocorticoid treatment in rheumatoid arthritis--a debate

Arguments are presented for and against the use of oral glucocorticoid treatment in patients with rheumatoid arthritis. Controlled clinical trials, uncontrolled longitudinal observations and accumulated clinical experience are drawn together to place in perspective treatment decisions in routine clinical practice. The evidence points to a relatively short term improvement in symptom control and a longer term benefit in reducing progressive joint destruction, but to this must be added fears about inappropriate prescription of glucocorticoids with consequent adverse effects. Areas requiring further research are highlighted.