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Glucocorticoid Tendon Effects — SCE Rheumatology MCQ

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ModerateSoft Tissue RheumatologyGlucocorticoid Tendon EffectsSCE Rheumatology

A 55-year-old woman with rheumatoid arthritis and stable low disease activity develops atraumatic right shoulder pain. Ultrasound demonstrates a full-thickness supraspinatus tear with tendon retraction. She has taken oral prednisolone 7.5 mg daily for 8 years. Which statement most accurately describes the relationship between glucocorticoid exposure and tendon pathology?

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Correct answer: A — Long-term oral prednisolone is associated with tendon rupture and adverse effects on tenocyte and extracellular-matrix function

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as E

Long-term systemic glucocorticoid exposure is associated with tendon pathology and rupture. Oral glucocorticoid use has demonstrated a dose-related association with tendon rupture, while experimental evidence shows impaired tenocyte proliferation, collagen and extracellular-matrix synthesis, and deterioration of tendon mechanical properties. Prednisolone's UK SmPC specifically lists tendinopathy and tendon rupture as adverse effects. This exposure may therefore have contributed to the tear, although it does not prove that prednisolone alone caused it; age and rheumatoid disease are additional risk factors. A and E incorrectly deny the recognised rupture risk. C is incorrect because tendon toxicity is not limited to injections. D reverses the observed biological effect: suppression of inflammation does not translate into increased tendon strength.

Reference: Wockhardt UK Ltd. Prednisolone 5 mg Tablets, Summary of Product Characteristics, section 4.8 Musculoskeletal and connective tissue disorders. Current eMC document; last updated 25 May 2021. https://www.medicines.org.uk/emc/product/2427/smpc