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A taskforce from the European League Against Rheumatism (EULAR) has produced evidence-based recommendations for the management of systemic glucocorticoid therapy in rheumatic diseases.
The authors of the recommendations noted that systemic glucocorticoids were the most widely used anti-inflammatory and immuno-suppressive drugs in rheumatic diseases, and that debate over their safe use had been renewed by recent evidence that in low-dose these drugs may have had disease-modifying effects.
The aim of these recommendations was to summarise the evidence available to support their safe use.
At the start of the process, a series of ten propositions related to the safe use of glucocorticoids was generated using the Delphi Method, and once these were agreed, a comprehensive literature search was carried out to identify the best available evidence to support each of the ten propositions.
This evidence was then used to generate and validate recommendations and to formulate an agenda for future research.
Three Delphi rounds were required to generate the ten propositions, which included patient education, risk factors, adverse effects, concomitant therapy (non-steroidal anti-inflammatory drugs, gastroprotection and cyclo-oxygenase-2 selective inhibitors, calcium and vitamin D, bisphosphonates) and special safety advice (adrenal insufficiency, pregnancy, growth impairment).
For each of these, the evidence was summarised to produce recommendations for practice.
In a number of areas, the evidence was weak (dosing and tapering strategies, timing, risk factors and monitoring for adverse effects, perioperative replacement), and for these further research was recommended.