Effects of glucocorticoids on inflammation and arthritis

PURPOSE OF REVIEW: Glucocorticoids are used in the treatment of most rheumatic diseases, and are used chronically in up to 50% of cases of rheumatoid arthritis. The frequency of their use has in the past been incompletely supported by trial evidence of their benefit and by incomplete understanding of their mechanisms of action. The present review will examine significant recent publications relating to glucocorticoids of relevance to rheumatology RECENT FINDINGS: The basic science of glucocorticoid action has advanced considerably in the review period. Major advances include demonstration of the function of glucocorticoid-induced anti-inflammatory proteins such as mitogen-activated protein kinase phosphatase-1, expanded understanding of alternately spliced isoforms of the glucocorticoid receptor, and major steps in understanding factors regulating glucocorticoid sensitivity in disease. Clinical studies have also had major developments, most strikingly with the publication of two randomized prospective studies on the efficacy of glucocorticoids in preventing erosions in rheumatoid arthritis. SUMMARY: Despite over 50 years of glucocorticoid use in rheumatology, basic science and clinical studies continue to yield intriguing new data. The quest for therapeutic agents with the beneficial effects of glucocorticoids but lacking their harmful effects is aided by this progress.