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Gradual glucocorticoid tapering reduces long-term organ damage and systemic adverse effects in rheumatoid arthritis and systemic lupus erythematosus, despite a manageable risk of flare.
A novel systematic review highlights the significant safety concerns linked with prolonged glucocorticoid (GC) therapy in rheumatoid arthritis and systemic lupus erythematosus (SLE), while reinforcing the clinical benefits of tapering and discontinuation strategies.
Analyzing evidence from randomized controlled trials and observational cohort studies, researchers evaluated adverse effects, withdrawal symptoms, and disease outcomes tied to long-term GC use. The review followed PRISMA 2020 standards and assessed study quality using validated risk-of-bias tools, identifying 10 studies with low-to-moderate bias for final synthesis.
Prolonged GC therapy is consistently linked with an extensive range of systemic adverse effects. While discontinuation raises concerns about disease flare, especially in autoimmune conditions, the overall evidence suggests that reducing and stopping GC therapy triggers lower long-term organ damage—particularly in SLE—and fewer cumulative complications.
The findings strongly support current recommendations from the European Alliance of Associations for Rheumatology (EULAR), emphasizing that GCs must be tapered and discontinued whenever clinically feasible. Gradual dose reduction is shown to be safer and more effective than abrupt cessation, minimizing withdrawal symptoms and improving patient outcomes.
Experts stress that individualized tapering strategies are fundamental, taking into account disease activity, patient response, and risk of flare. Despite the challenges of withdrawal, the long-term benefits of minimizing GC exposure position discontinuation as a key component of standard care in rheumatoid arthritis and SLE management.
Cureus
Adverse Effects and Withdrawal Symptoms of Prolonged Glucocorticoid Therapy in Chronic Rheumatoid Arthritis and Systemic Lupus Erythematosus: A Systematic Review
Lincoln Xavier Naranjo Palacio et al.
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