Benefits and Complications of Long-Term Low-Dose Glucocorticoids in Rheumatoid Arthritis: A Traditional Review

Long-term low-dose glucocorticoid therapy remains widely used in rheumatoid arthritis (RA), despite concerns regarding cumulative toxicity.This traditional review evaluates the clinical benefits and complications of oral glucocorticoids at doses of ≤7.5 mg/day prednisone equivalent in adults with RA, with particular attention to disease control, bone health, cardiovascular outcomes, infection, and glucocorticoid withdrawal.A literature search of PubMed Advanced, PubMed Central, and Google Scholar conducted from July 1 to October 9, 2026, identified 56 potentially relevant studies, of which 36 were selected for qualitative synthesis.Evidence from randomized controlled trials, observational cohorts, systematic reviews, metaanalyses, and clinical guidelines was evaluated.Low-dose glucocorticoids provide measurable clinical benefits, including reduced disease activity, prevention of disease flares, and slowing of radiographic joint damage.However, these benefits must be balanced against cumulative adverse effects.Infection was the most consistently demonstrated complication, with observational evidence showing an increased risk even at doses of ≤5 mg/day.Evidence regarding skeletal toxicity was mixed: observational studies associated low-dose glucocorticoids with reduced bone mineral density (BMD) and increased fracture risk, whereas randomized trial data suggested less pronounced effects when inflammation was controlled and bone-protective therapy was used.Cardiovascular risk also remained uncertain at very low doses and was influenced by baseline cardiovascular risk and cumulative exposure.Early initiation of effective biologic or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) was associated with greater success in glucocorticoid discontinuation, while tapering could increase the risk of disease flare in patients with established low disease activity.Overall, low-dose glucocorticoids retain clinically meaningful efficacy in RA, but long-term use is associated with important cumulative risks, particularly infection.When continued therapy is necessary, the minimum effective dose should be used with regular reassessment and appropriate monitoring and preventive measures.When disease control permits, gradual tapering and steroid-sparing therapy should be prioritized.