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Glucocorticoid Bridging in RA — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisGlucocorticoid Bridging in RASCE Rheumatology

A 55-year-old woman with RA and diabetes has been on Prednisolone for RA flare management. Her HbA1c has risen from 52 to 68 mmol/mol. According to EULAR 2022 what is the recommended approach to glucocorticoid use in RA?

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Correct answer: A — Glucocorticoids should be used as bridging therapy during DMARD initiation or flare then tapered and ideally withdrawn within 3 months to minimise metabolic and other adverse effects

EULAR 2022 recommends glucocorticoids as short-term bridging therapy during DMARD initiation or disease flares with the aim of tapering and withdrawing within 3 months. Long-term glucocorticoid use causes significant metabolic complications (diabetes weight gain dyslipidaemia) osteoporosis cardiovascular risk infection risk and adrenal suppression. The GLORIA trial showed that very low dose Prednisolone (5 mg daily) added to standard therapy in elderly RA patients reduced flares but increased infections. The goal should always be effective DMARD/biologic therapy allowing glucocorticoid withdrawal.

Reference: EULAR 2022 RA recommendations; Boers M et al 2020 GLORIA trial