The current role of GCs in rheumatic diseases

Without any doubt, GCs at higher dosages are needed to terminate flares and/or to reduce the activity of rheumatic diseases. However, this ‘emergency’ usage represents only one option for successfully administering these drugs since many patients are more or less continuously treated with ‘maintenance treatment’.

For example, when looking at rheumatoid arthritis (RA), it is obvious that, very often, lower dosages of GCs are given in combination with conventional or biological disease-modifying anti-rheumatic drugs (DMARDs) (and, of course, other drugs such as non-steroidal anti-inflammatory drugs or analgesics). This therapeutic approach has the following rationale: a sensible combination of drugs with different modes of action ideally results in additive or even synergistic effects, while potential adverse effects remain at a level associated with the dose of each component. For GC treatment, this means that the more effective the treatment is with DMARDs, the lower can be the GC dosages. Consequently, less pronounced adverse effects are induced by these drugs (figure 1).

Given the widespread and successful usage of biological DMARDs, what does this mean in terms …