Article type
Abstract
Background:
Despite advances in the treatment of rheumatoid arthritis (RA) with disease-modifying therapies (DMARDs), glucocorticoids remain a common intervention. Given the known adverse effects associated with glucocorticoids, there is uncertainty regarding the optimal use of glucocorticoids in RA.
Objectives:
To develop Australian recommendations on the use of glucocorticoids in people with RA.
Methods:
We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to develop four recommendations on the use of glucocorticoids in RA for treating flare, as bridging therapy during DMARD introduction, long-term use of low-dose glucocorticoids, and perioperative adjustment of glucocorticoids. The recommendations form part of the NHMRC-approved Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis (www.mskguidelines.org). The guideline employs ‘living evidence’ methodology, in which individual recommendations are updated in near real-time as new evidence emerges. Separate panel meetings were convened for each recommendation. Guideline panels comprised consumers and clinicians with expertise in rheumatology, primary care, pharmacy and allied health (see Attachment 1). Panellists were provided with comprehensive evidence summaries including summary of findings tables synthesising the certainty of evidence for each important outcome.
Results:
The panel made conditional recommendations in favour of short-term use of glucocorticoids in people with active RA during initiation or change in DMARD therapy, and for the treatment of disease flare, but made a conditional recommendation against long-term (> 6 months) use of glucocorticoids as an adjunct to DMARDs. The panel also made a conditional recommendation against the use of perioperative ‘stress dosing’ in people taking regular glucocorticoids for inflammatory arthritis.
Conclusions:
Balancing the benefits and harms of glucocorticoids in people with RA remains a challenge. These Australian evidence-based recommendations provide guidance to clinicians on the use of glucocorticoids in different clinical scenarios. The recommendations are freely available via a web-based application and will continue to be updated as relevant new evidence emerges.
Despite advances in the treatment of rheumatoid arthritis (RA) with disease-modifying therapies (DMARDs), glucocorticoids remain a common intervention. Given the known adverse effects associated with glucocorticoids, there is uncertainty regarding the optimal use of glucocorticoids in RA.
Objectives:
To develop Australian recommendations on the use of glucocorticoids in people with RA.
Methods:
We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to develop four recommendations on the use of glucocorticoids in RA for treating flare, as bridging therapy during DMARD introduction, long-term use of low-dose glucocorticoids, and perioperative adjustment of glucocorticoids. The recommendations form part of the NHMRC-approved Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis (www.mskguidelines.org). The guideline employs ‘living evidence’ methodology, in which individual recommendations are updated in near real-time as new evidence emerges. Separate panel meetings were convened for each recommendation. Guideline panels comprised consumers and clinicians with expertise in rheumatology, primary care, pharmacy and allied health (see Attachment 1). Panellists were provided with comprehensive evidence summaries including summary of findings tables synthesising the certainty of evidence for each important outcome.
Results:
The panel made conditional recommendations in favour of short-term use of glucocorticoids in people with active RA during initiation or change in DMARD therapy, and for the treatment of disease flare, but made a conditional recommendation against long-term (> 6 months) use of glucocorticoids as an adjunct to DMARDs. The panel also made a conditional recommendation against the use of perioperative ‘stress dosing’ in people taking regular glucocorticoids for inflammatory arthritis.
Conclusions:
Balancing the benefits and harms of glucocorticoids in people with RA remains a challenge. These Australian evidence-based recommendations provide guidance to clinicians on the use of glucocorticoids in different clinical scenarios. The recommendations are freely available via a web-based application and will continue to be updated as relevant new evidence emerges.