With the introduction and use of biologics, rheumatoid arthritis now has a much higher efficacy and prognosis. However, for many patients with rheumatoid arthritis, the use of biologics also inevitably has many limitations, so the use of hormones has come to the forefront of the new agenda. In the 1950s, glucocorticoids were heavily used in the treatment of rheumatoid arthritis (RA), but long-term 20 mg-40 mg/d could cause serious adverse effects and were thereafter discouraged.
In 1995, Kirwan concluded that prednisone 7.5 mg/d could be used as an adjunctive treatment for early active RA, significantly delaying the radiological progression of osteoarthritic destruction and providing disease control. Therefore, for the use of hormones, I only point out my personal opinion: Lv Tingting, Department of Rheumatology and Immunology, Tangdu Hospital, Fourth Military Medical University 1, small doses of prednisone for RA are safe and effective
The daily dose of prednisone should not exceed 10mg.d-1. Small doses of prednisone can relieve the symptoms of RA and have disease control effects, and should be used in combination with other slow-acting anti-rheumatic drugs. It is recommended to take calcium and vitamin D at the same time, and monitor bone density by dual energy X-ray absorptiometry (DEXA). 2.Whether high-dose glucocorticoid therapy is needed for RA
In 1997, Boers et al. showed that the initial dose of prednisone was 60 mg/d, which was reduced to 7.5 mg/d six times over six weeks and then discontinued at 35 weeks. The majority of patients with early active RA with more severe symptoms showed significant, rapid and marked improvement in outcome. The initial dose of prednisone and the timing of its use are critical to its subsequent clinical effects. Combination therapies, including high-dose prednisone, continue to suppress damage in patients with early RA for many years, demonstrating significantly slower progression of joint destruction at follow-up. However, the problems associated with high-dose glucocorticoids are increased patient mortality, prominent adverse effects, and poor patient tolerability. 3. Whether high-dose hormones are needed during the window period
Some studies have shown that only 10-20% of patients need to take prednisone at a dose of 10mg/d or more. Therefore, further clinical trials are needed to determine whether all patients taking glucocorticoids need to apply high-dose hormone therapy during the “window period”. In general, the proper use of glucocorticoids in the treatment of RA has been accepted by most rheumatologists. Some surveys have found that 72% of RA patients in the United States have used glucocorticoids, 58% of RA patients in Europe have used glucocorticoids, and 52% of RA patients in China have used glucocorticoids. Glucocorticosteroids can be used as a corrective therapy in the treatment of RA, i.e., glucocorticosteroids are used for 2-3 months before the slow-acting drugs for the treatment of RA take effect, and then the glucocorticosteroids are reduced after the slow-acting drugs take effect, which can effectively control the disease and reduce the pain, and at the same time reduce the adverse effects of glucocorticosteroids. The newly proposed targeted therapy for rheumatoid arthritis has brought the use of hormones to a new level.