Background: Glucocorticoids (GCs) have been a cornerstone of the management of rheumatoid arthritis (RA) since the early 1950s. For a long time GCs have been one of the few available therapeutic options with a brilliant clinical result. In addition, due to their rapid effect, GCs have an appealing profile for treating flares or as “bridging” therapy in early RA. However, despite their benefits, they have equally well-known adverse effects and it is generally accepted that long-term use of GCs, particularly at higher doses, is not advisable. As a matter of fact, the recently published guidelines for the management of RA either recommend against the use of glucocorticoids or suggest using them only as bridging therapy. Nonetheless, prolonged glucocorticoid therapy at low doses is still highly prevalent in clinical practice.

Objectives: The aim of this cross-sectional study was to analyse the prevalence of chronic GCs use in clinical practice for RA. In addition we evaluated the main reasons for lack of glucocorticoid discontinuation and the association with the clinical features of the patients.

Methods: We enrolled 143 consecutive RA patients fulfilling ACR/EULAR 2010 criteria. For each patient demographic, clinical and laboratory data were collected during the routine visit. In particular, dosage and duration of GC therapy were recorded. Data were expressed as mean ± standard deviation or as median (IQR) according to distribution. Mann Whitney and Spearman tests were performed for comparisons and p value < 0.05 was considered statistically significant.

Results: Of 143 patients, 68 (47.6%) stopped GCs while 75 (52.4%) were still receiving GCs. The two groups were not significantly different in age, gender, disease duration, number of previous line of treatment, concomitant treatment, disease status (Table 1). Among them, 27 (36%) took short-term GCs therapy (< 3 months), while 46 (61.3%) never stopped, having taken GC for a mean duration of 55.4±10.88 months at a mean dose of 4.74±4,31 mg/day. The main reason for chronic GC use was “rheumatologists’ prescription due to disease flare” (26, 56.5%); patients discontinuation was never proposed to 12 (26%) patients. Five more patients (10.9%) took GCs by their own decision. Of note, among patients who never stopped GCs, 30 (47.9%) were on low activity disease activity or remission (65.2%). Older age was associated with no GCs discontinuation (p=0.002). Lack of GC discontinuation correlated with treatment duration and starting dose (p=0.002; p<0.001) that positively correlated with each other (p<0.001) (Figure1).

Conclusion: Discontinuation of GCs therapy is still an unmet need in the current strategy for treat to target, partially because of disease flares but possibly due to a lack of a “tapering to discontinuation” protocols reassuring rheumatologists that RA flare-up can occur. Based on our preliminary data, prolonged treatment and higher starting GCs dose hampers discontinuation, even in patients in low disease activity and remission. These results should support the limitation of GC use as advised by the latest EULAR recommendations.

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REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: Federica Maria Ucci: None declared, Claudia Ciancarella: None declared, Francesca Romana Di Ciommo: None declared, Lorenzo Di Sanzo: None declared, Cristina Garufi: None declared, Rossana Scrivo: None declared, Fulvia Ceccarelli: None declared, Cristiano Alessandri: None declared, Fabrizio Conti Abbvie, Pfizer, Galapagos, UCB, Eli Lily, AstraZeneca, GSK, Francesca Romana Spinelli Galapagos, UCB, Eli Lily, AstraZeneca, GSK.