3 views on steroids in RA

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Steroids might be one of the most controversial topics in rheumatology. The class of medication simultaneously has some of the most powerful disease treating effects but also numerous, severe side effects. I frequently interact with some patients who refuse to be on them at all even when really necessary and other appear to be addicted demanding them even when inappropriate.

This month The Rheumatologist has an interesting series of three editorials by eminent rheumatologists arguing three separate platforms on the use of steroids in RA: they should always be used, they should never be used, and a low dose of 3mg daily is safe and effective.

  1. Steroids are bad.
  2. Steroids are good.
  3. 3 mg Prednisone is great.

The editorials address such topics as:

  1. Disease modifying properties
  2. Increased mortality
  3. Setting a bad example for PCPs

I strongly recommend reading all three editorials and their source articles. The ACR will be working on new treatment guidelines in the near future with the use of steroids as one of the key issues to be addresses.

In my own practice, I try to limit the use of steroids as much as possible, especially to avoid a masking effect when the diagnosis is unclear or when incrementing DMARD therapy.

I look forward to future research and debate on this issue.