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43. Kongress der Deutschen Gesellschaft für Rheumatologie, 29. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie, 25. Wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie

02.-05. September 2015, Bremen

Defining the conditions under which different glucocorticoid doses have a good benefit-risk ratio

Meeting Abstract

  • Cindy Strehl - Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Berlin
  • Hans Bijlsma - University Medical Center Utrecht, Department of Rheumatology & Clinical Immunology, Utrecht, The Netherlands
  • Maarten de Wit - Medical Humanities, VU Medical Centre, Amsterdam, Netherlands
  • Maurizio Cutolo - Universita degli Studi di Genova, Genova, Italy
  • Raphaele Seror - Department of Rheumatology, Hopitaux de Paris, Le Kremlin Bicêtre, Paris, France
  • Kevin Winthrop - Divisions of Infectious diseases, Oregon Health & Science University, Portland, United States
  • Frank Buttgereit - Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Berlin

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 43. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh); 29. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh); 25. wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Bremen, 02.-05.09.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocRA.28

doi: 10.3205/15dgrh196, urn:nbn:de:0183-15dgrh1963

Published: September 1, 2015

© 2015 Strehl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Introduction: Glucocorticoids (GC) are used to treat inflammatory diseases including rheumatic and musculoskeletal diseases. EULAR-recommendations on GC-therapy are up to date but uncertainty about the benefit-risk-ratio persists. Bearing in mind the known beneficial effects of GC, the aim of an EULAR task-force was to achieve consensus when formulating conditions under which GC have a good benefit-risk-ratio.

Methods: Focussing on the four most worrisome adverse effects (AE) of GC (cardiovascular disease (CVD), effects on bone, GC-induced hyperglycaemia & diabetes mellitus and infections), a systematic literature review was performed and discussed with the experts. One breakout group per AE discussed the relevant evidence in detail and presented their results following a structured questionnaire, addressing dose-harm-relationships, patient characteristics, co-morbidities, co-medications and both preventive and therapeutic measures for final discussion.

Results: Initially, there was consensus about the beneficial effects of GC also at low dosages and that data on AE are limited, sometimes both contradictory and biased. The task force members agreed that for the majority of patients:

  • at dosages ≤5mg/d prednisone equivalent benefits are greater than risks with the exception of patients at high risk for CVD who may require preventive measures
  • at dosages >10mg/d risks are greater than benefits, with the exception of patients with GC resistance.

At dosages between >5 and ≤10mg/d, the benefit-risk-ratio depends on patient-specific characteristics such as disease activity, additional risk factors and preventive measures. Early diagnosis, low disease activity, low cumulative GC-dosage, healthy lifestyle and both, monitoring and treatment of risk-factors and co-morbidities, respectively, represent factors reducing the risk, thereby improving the benefit-risk ratio. For each AE, specific factors can affect the risk and, therefore, the benefit-risk-ratio in both directions. For some GC induced AE specific patient groups are at higher risk, certain co-morbidities increase the risk and the genetic background and specific disease characteristics may affect the benefit-risk-ratio. Thus, the benefit-risk-ratio varies between individuals; consequently our consensus is valid for the majority of patients rather than every individual patient.

Conclusion: There is no absolute condition or conditions under which GC always have good benefit-risk-ratios. However, based on currently available evidence, our consensus provides the rationale to accomplish a relatively safe use of GC in the majority of patients.