The therapeutic landscape of rheumatoid arthritis (RA) has rapidly evolved in the
last few decades. At the same time, recommendations for the management of the disease
suggest to minimize glucocorticoids (GCs) use in RA patients. Major concerns are the
risk of long-term adverse events and the difficulties in discontinuing GCs once initiated.
However, real-world data show that up to 50% of RA patients continue to take GCs during
the disease course. Adverse events of GCs usually occur after a long-term use, which
can limit the generalizability of randomized controlled trials (RCTs) proving no or
minimal harm. Observational studies show conflicting results regarding the safety
of GSs and are subjected to a high risk of bias, including indication bias. Thus,
whether or not GCs should be used in the management of RA is still a matter of debate.
The main reasons to support GCs use are the ability to rapidly suppress joint inflammation
while waiting for the full effect of conventional synthetic disease-modifying antirheumatic
drugs (csDMARD) and the acknowledged efficacy on radiographic progression in early
RA. The main reasons to avoid GCs use in RA are that their potential risks may outweigh
their benefits and there is no agreement on the minimal daily dosage of GC which can
be considered safe.
