The value of glucocorticoid co - therapy in diff erent rheumatic diseases – positive and adverse eff ects

Th e value of glucocorticoid therapy was discovered 65 years ago. In 1949, Philip Hench reported the dramatic eff ect of compound E on rheumatoid arthritis (RA) [1]. Nowadays, glucocorticoids play a pivotal role in the management of many infl ammatory rheumatic diseases [2-7]. Glucocorticoids represent the most frequently em ployed class of anti-infl ammatory drugs, with a rise in use in recent years [8-11], despite the development of new treatment modalities such as biological drugs applicable for many rheumatic diseases. Community survey data indicate use of glucocorticoids among 0.5% of the general population, and 1.4% of women aged older than 55 years [12,13]. Between 14.6 and 90% of patients with RA worldwide are undergoing treatment with gluco corticoids [10]. Almost all patients with polymyalgia rheumatic, giant cell arteritis and systemic vasculitis use systemic glucocorticoids. Glucocorticoids are very eff ective anti-infl ammatory and immunosuppressive drugs, but their use is restrained by fear for and occurrence of adverse eff ects (Figure 1).