Published in:
01-10-2020 | Tuberculosis | Editorial
The perennial search for alternatives to corticosteroids in rheumatology: is there light at the end of the tunnel?
Authors:
Durga Prasanna Misra, Vikas Agarwal
Published in:
Clinical Rheumatology
|
Issue 10/2020
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Excerpt
Rheumatology as a specialty has undergone dramatic transformation in the available armamentarium for treatment options during the past seven decades, ever since the use of corticosteroids was first described in rheumatoid arthritis (RA). However, the recent article by Wang and Panush in the journal suggests that little has changed during this time with regard to corticosteroid use [
1]. Particularly concerning was the fact that nearly two-thirds of patients with systemic lupus erythematosus (SLE) admitted to their wards were on high-dose corticosteroids, similar to the proportion of patients in a historical control of lupus patients from the 1950s [
1,
2]. The comparisons for patients with RA were probably hindered by the smaller number of patients (nine), most of whom were on corticosteroids, when compared with nearly two-thirds in the 1980s and early 1990s and one-third in the late 1990s and 2000s [
1,
3]. However, there were issues associated with the chosen historical controls [
4]. Although both lupus cohorts were hospital-based, the clinical characteristics of the lupus cohort in the 1950s as well as in the present study were not available; hence, inferences about severity of disease and the need for immunosuppressive therapy could not be made [
1,
2]. The comparisons for RA patients, based on hospitalized patients in the present study with population-based historical cohorts, were more difficult to justify [
1,
3]. Nevertheless, the authors have raised an important point about the need to evaluate critically the status of therapeutic strategies for rheumatic diseases that minimize corticosteroid use. This is particularly an ethical issue in high-income countries; costlier, newer therapies are more accessible than in lesser economically developed regions of the world. In this article, we revisit the adverse effects associated with corticosteroid therapy and critically evaluate how far we have actually reached in our search for lesser evils as alternatives to corticosteroids. …
