Cited by 604Rheumatoid Arthritis Research and TherapiesAdrenal Hormones and DisordersPharmacovigilance and Adverse Drug Reactions

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Dose-related patterns of glucocorticoid-induced side effects

Huscher, D, Thiele, K, Gromnica-Ihle, E, Hein, G, Demary, W, Dreher, R, Zink, A, Buttgereit, F·2009·Annals of the Rheumatic Diseases

DOI 10.1136/ard.2008.092163

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Abstract

Objective To identify patterns of self-reported health problems relating to dose and duration of glucocorticoid intake in unselected patients with rheumatoid arthritis from routine practice. Methods Data from 1066 patients were analysed. The clinical status and drug treatment were reported by the physician, health problems during the past 6 months by the patient using a comprehensive list of symptoms. Patients with ongoing glucocorticoid treatment for more than 6 months and current doses of less than 5, 5-7.5 and over 7.5 mg/day prednisone equivalent were compared with a group without any glucocorticoid treatment for at least 12 months. Results The frequency of self-reported health problems was lowest in the group without glucocorticoid exposition and increased with dosage. Two distinct dose-related patterns of adverse events were observed. A "linear" rising with increasing dose was found for cushingoid phenotype, ecchymosis, leg oedema, mycosis, parchment-like skin, shortness of breath and sleep disturbance. A "threshold pattern" describing an elevated frequency of events beyond a certain threshold value was observed at dosages of over 7.5 mg/day for glaucoma, depression/listlessness and increase in blood pressure. Dosages of 5 mg/day or more were associated with epistaxis and weight gain. A very low threshold was seen for eye cataract (<5 mg/day). Conclusion The associations found are in agreement with biological mechanisms and clinical observations. As there is a paucity of real-life data on adverse effects of glucocorticoids prescribed to unselected groups of patients, these data may help the clinician to adapt therapy with glucocorticoids accordingly and improve the benefit-risk ratio.

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Authors: Huscher, D., Thiele, K., Gromnica-Ihle, E., Hein, G., Demary, W., Dreher, R., Zink, A., & Buttgereit, F.
Affiliations: German Rheumatism Research Centre (DE)
Jena University Hospital (DE)
Charité – Universitätsmedizin Berlin (DE)
Corresponding author: Huscher, D
ORCID: Huscher, D
Thiele, K
Zink, A
Buttgereit, F
Venue: Annals of the Rheumatic Diseases
Publisher: Elsevier BV
Published: 2009-07
Volume: 68
Issue: 7
Pages: 1119-1124
ISSN: 0003-4967 (ISSN-L)
DOI: 10.1136/ard.2008.092163
OpenAlex: W2167459187
Cited by: 604
References: 35
Citations by year: 2026: 43 · 2025: 55 · 2024: 67 · 2023: 55 · 2022: 47 · 2021: 41 · 2020: 49 · 2019: 38 · 2018: 27 · 2017: 28 · 2016: 32 · 2015: 21 · 2014: 26 · 2013: 28 · 2012: 19
FWCI: 6.18
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Annals of the Rheumatic Diseases (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Topics: Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
Keywords: glucocorticoid adverse effects, dose-response relationship, rheumatoid arthritis, prednisone-equivalent dose, glaucoma, cataract, depression, hypertension, weight gain, bruising, lower limb edema, fungal infection, sleep disorders, risk-benefit ratio, threshold dose
MeSH terms: Arthritis, Rheumatoid, Data Collection, Dose-Response Relationship, Drug, Female, Glucocorticoids, Humans, Male, Middle Aged, Risk Factors, Time Factors

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Dose-related patterns of glucocorticoid-induced side effects

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