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Glucocorticoids in rheumatoid arthritis still on first line: the reasons
Abstract
Glucocorticoids (GCs) are the most prescribed drugs in the management of inflammatory musculoskeletal diseases, such as rheumatoid arthritis (RA). However, a very recent review accurately retraced ...
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The documented efficacy of low-dose prednisone may be related to impaired adrenal reserve in rheumatoid arthritis and supports adding glucocorticoids as replacement therapy.
“Taken together, the documented efficacy of complementary low-dose prednisone may be related to our findings of an impaired adrenal reserve in patients with RA described here and supports the addition of glucocorticoids in RA treatment regimens, as a potential ‘replacement’ therapy.11 58”
From Diurnal production of cortisol and prediction of treatment response in rheumatoid arthritis: a 6-month, real-life prospective cohort study (2024) · cites this paper as [58]
Citations
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Self-citationThe 70th anniversary of glucocorticoids in rheumatic diseases: the second youth of an old friend
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Self-citationCorticotrophin (ACTH) in Rheumatoid Arthritis
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Martinez, G. J., Appleton, M., Kipp, Z. A., Loria, A. S., Min, B., & Hinds, T. D. (2023) · Physiological Reviews · doi:10.1152/physrev.00021.2023 · Cited by 115
Macrophage-Targeted Hydroxychloroquine Nanotherapeutics for Rheumatoid Arthritis Therapy
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Cutolo, M., Soldano, S., Gotelli, E., Montagna, P., Campitiello, R., Paolino, S., Pizzorni, C., Sulli, A., Smith, V. M., & Tardito, S. (2021) · Arthritis Research & Therapy · doi:10.1186/s13075-021-02691-9 · Cited by 49
Self-citationTransdermal delivery of inflammatory factors regulated drugs for rheumatoid arthritis
Zhang, Y., Gao, Z., Chao, S., Lu, W., & Zhang, P. (2022) · Drug Delivery · doi:10.1080/10717544.2022.2089295 · Cited by 42
“Although low-dose oral administration of GCs is an effective route of administration, it needs optimal time selection when used, so it has poor compliance, while it has large systemic adverse reactions with long-term usage (Cutolo et al., 2021).”
BackgroundChronobiology and Chronotherapy in Inflammatory Joint Diseases
Ursini, F., Giorgi, A. D., D'Onghia, M., Giorgio, R. D., Fabbian, F., & Manfredini, R. (2021) · Pharmaceutics · doi:10.3390/pharmaceutics13111832 · Cited by 36
“This enzyme converts peripheral inactive cortisone into cortisol, therefore exerting negative feedback on hypothalamic ACTH release and consequently on adrenal cortisol production [57].”
BackgroundTo treat or not to treat rheumatoid arthritis with glucocorticoids? A reheated debate
Cutolo, M., Shoenfeld, Y., Bogdanos, D. P., Gotelli, E., Salvato, M., Gunkl-Tóth, L., & Nagy, G. (2023) · Autoimmunity Reviews · doi:10.1016/j.autrev.2023.103437 · Cited by 23
“Alongside other significant clinical benefits, although partially limited by dose-related side effects, GCs are still on the first line together with csDMARDs in early RA [15,22].”
Self-citationPros and cons of NRF2 activation as adjunctive therapy in rheumatoid arthritis
Manda, G., Milanesi, E., Genç, Ş., Niculite, C. M., Neagoe, I. V., Tastan, B., Dragnea, E. M., & Cuadrado, A. (2022) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2022.08.012 · Cited by 22
Adrenocortical dysfunction in rheumatoid arthritis: Α narrative review and future directions
Filippa, M. G., Tektonidou, M. G., Mantzou, A., Kaltsas, G., Chrousos, G. P., Sfikakis, P. P., & Yavropoulou, M. P. (2021) · European Journal of Clinical Investigation · doi:10.1111/eci.13635 · Cited by 19
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“In this way, GCs, when externally supplemented, can act as a “replacement therapy” to restore cortisol levels in the serum to an adequate amount [21].”
BackgroundSelf-citationNazakat, L., Ali, S., Summer, M., Nazakat, F., Noor, S., & Riaz, A. (2025) · Inflammopharmacology · doi:10.1007/s10787-025-01664-7 · Cited by 15
Yavropoulou, M. P., Filippa, M. G., Vlachogiannis, N. I., Fragoulis, G. E., Laskari, K., Mantzou, A., Panopoulos, S., Fanouriakis, A., Bournia, V.-K., Evangelatos, G., et al. (2024) · RMD Open · doi:10.1136/rmdopen-2023-003575 · Cited by 13
“11 58 The main limitations of our pilot study include the following: first, the sample size was relatively small and patients with both early and established RA were included.”
Identifying hub circadian rhythm biomarkers and immune cell infiltration in rheumatoid arthritis
Wen, P., Ma, T., Zhang, B.-F., Hao, L., Wang, Y., Guo, J., Song, W., Wang, J., & Zhang, Y. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.1004883 · Cited by 12
Petráčková, A., Hořák, P., Savara, J., Skácelová, M., & Kriegová, E. (2024) · Frontiers in Immunology · doi:10.3389/fimmu.2024.1505615 · Cited by 11
State-of-the-art glucocorticoid-targeted drug therapies for the treatment of rheumatoid arthritis
Pelechas, E., & Drosos, A. A. (2022) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2022.2049238 · Cited by 8
Skácelová, M., Nekvindová, L., Mann, H. F., Závada, J., Křístková, Z., Vencovský, J., Pavelká, K., Hořák, P., & the ATTRA Registry (2022) · Rheumatology International · doi:10.1007/s00296-021-05072-2 · Cited by 8
“We expect early results of a randomized, double-blind, clinical trial GLORIA (Glucocorticoid Low-dose Outcome in RA) which evaluates the safety and the effectiveness of low dose GCs (5 mg per day of prednisolone versus placebo) in elderly RA patients over 65 years [39, 40].”
BackgroundRecent Advancement in Drug Delivery Systems for the Treatment of Rheumatoid Arthritis
Singh, N., & Choudhary, R. (2025) · Current Drug Discovery Technologies · doi:10.2174/0115701638376838250701221200 · Cited by 3
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Self-citationMulti-Technology Empowers Dissolving Microneedles: A Novel Strategy in Rheumatoid Arthritis
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Ohashi, Y., Suzuki, M., Sobue, Y., Terabe, K., Asai, S., Imagama, S., & Takahashi, N. (2026) · International Journal of Rheumatic Diseases · doi:10.1111/1756-185x.70758
Metadata
- Authors
- Cutolo, M., Paolino, S., & Gotelli, E.
- Affiliations
- Ospedale Policlinico San Martino (IT)
- Corresponding author
- Cutolo, Maurizio
- Venue
- Expert Review of Clinical Immunology
- Publisher
- Informa UK Limited
- Published
- 2021-03-19
- Volume
- 17
- Issue
- 5
- Pages
- 417-420
- ISSN
- 1744-666X (ISSN-L)
- 1744-8409
- OpenAlex
- W3134183063
- Cited by
- 23
- References
- 25
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 7 · 2021: 3
- FWCI
- 3.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Expert Review of Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- Funders
- not funded
- Topics
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Hematology › Autoimmune and Inflammatory Disorders Research
- Health Sciences › Medicine › Complementary and alternative medicine › Natural Compounds in Disease Treatment
- Keywords
- glucocorticoids, rheumatoid arthritis, first-line therapy, anti-inflammatory therapy, corticosteroid prescribing
- MeSH terms
- Arthritis, Rheumatoid, Circadian Rhythm, Glucocorticoids, Humans, Antirheumatic Agents
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