Mintalová K. Current role of glucocorticoids in rheumatology

Czech version

Authors: K. Mintálová
Authors‘ workplace: Revmatologický ústav Praha
Published in: Čes. Revmatol., 33, 2025, No. 2, p. 80-90.
Category: Review Article

Overview

Mintalová K. The current role of glucocorticoids in rheumatology

Even more than 70 years after their discovery, glucocorticoids continue to hold a strong position in rheumatology and are widely used in the treatment of rheumatic diseases. They are highly effective, but their use is associated with a wide range of adverse effects. The identification of the cellular mechanisms responsible for the therapeutic effects of glucocorticoids remains complex, which has limited the success of efforts to develop selective agents that would eliminate unwanted effects. The extent of glucocorticoid-related adverse events depends on the dose and duration of treatment, as well as on the patient’s age and comorbidities. Glucocorticoid therapy is associated with risks such as arterial hypertension, dyslipidemia, impaired glucose tolerance, cushingoid features, osteoporosis, mood disturbances, gynecomastia (due to suppression of sex hormone production), skin atrophy, and ocular complications, including cataracts or glaucoma, among others. Given the broad availability of disease-modifying antirheumatic drugs (DMARDs) in modern rheumatology, there is general consensus that glucocorticoids should be used at the lowest effective dose and for the shortest possible duration (ideally up to 3 months). The preferred use is in the form of bridging therapy, taking advantage of their rapid onset of action. This article focuses on the current position of glucocorticoid therapy in rheumatology, emphasizing recent recommendations, clinical practice, and ongoing controversies regarding dosing, duration of use, and treatment-related risks.

Keywords:

glucocorticoids – Corticosteroid therapy – adverse effects – EULAR recommendations – ACR recommendations

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