Glucocorticoids and rheumatoid arthritis—a reappraisal

The role of glucocorticoids (GC's) in the management of Rheumatoid arthritis (RA) has been controversial ever since their initial discovery and therapeutic application in RA, in the late 1940s. On the one hand, they are indispensable for the treatment of RA and other autoimmune inflammatory conditions; on the other they have significant toxicity. The use of low dose GCs in the management of RA has been re-evaluated since the mid 1990s in a number of trials and there has been a couple of Cochrane reviews on the subject in the past 5 years. The mechanisms of action of these drugs are now better understood. Their toxicity in the context of RA has also been looked at more critically. There are exciting new GC's in the pipeline, which may have fewer side effects than the ones we currently use. This review summarises some of the key, current evidence we have for the rational use of GCs in RA.