The "official view" on glucocorticoids in rheumatoid arthritis - a systematic review of international guidelines and consensus statements

OBJECTIVE:

To describe the perception on the current role of systemic glucocorticoids (GC) in the management of rheumatoid arthritis (RA) by examining their importance and the current level of evidence in recent guidelines, and to identify open questions to be addressed in future guidelines and research projects.

METHODS:

Systematic literature review using the databases PubMed, EMBASE and Cochrane for guidelines on the pharmacological treatment of RA. Retrieved articles were evaluated regarding their quality using the AGREE II tool and scrutinized for all relevant information concerning the use of GC.

RESULTS:

All guidelines agree that GC, especially if given at low dosages and for a short duration, are an appropriate option in the treatment of RA. However, many recommendations remain vague as reliable and detailed evidence is scarce. Important aspects of GC therapy are partially or completely neglected, and the existing nomenclature is not used uniformly. Quality evaluation revealed flaws in many articles, concerning not only GC specific recommendations but also guideline quality in general.

CONCLUSION:

Current recommendations for use of GC in the management of RA are suboptimal. More rigorous evaluation of dosages, timing and duration of their use is needed. Existing nomenclature on glucocorticoid therapy should be used uniformly. 

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