Publique en esta revista
Información de la revista
Vol. 3. Núm. 6.
Páginas 262-269 (Noviembre - Diciembre 2007)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 3. Núm. 6.
Páginas 262-269 (Noviembre - Diciembre 2007)
Revisión
Acceso a texto completo
Uso de glucocorticoides en la artritis reumatoide. ¿Cuándo y cómo deben usarse los esteroides en la artritis reumatoide?
Use of Glucocorticosteroids in Rheumatoid Arthritis. How and When Should Steroids Be Used in Rheumatoid Arthritis?
Visitas
...
Lucía Silva Fernández, Mónica Fernández Castro, José Luis Andreu Sánchez??
Autor para correspondencia
jlandreu@arrakis.es

Correspondencia: Dr. J.L. Andreu Sánchez. Servicio de Reumatología. Hospital Universitario Puerta de Hierro. San Martín de Porres, 4. 28035 Madrid. España.
Servicio de Reumatología. Hospital Universitario Puerta de Hierro. Madrid. España
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas

Los glucocorticoides (GC) son un elemento fundamental en el tratamiento de la artritis reumatoide (AR). A pesar de su uso generalizado, en la actualidad todavía persiste el debate sobre las ventajas y los inconvenientes de su uso a dosis bajas en pacientes con AR. En los últimos años se han realizado diversos ensayos clínicos que pretenden definir tanto el beneficio de los GC como fármacos modificadores de la enfermedad en AR como sus efectos secundarios a largo plazo. Los resultados de estos ensayos proporcionan evidencia sólida de que los GC a bajas dosis poseen un efecto modificador del daño estructural en AR de corta evolución y de que sus efectos secundarios, usados en dichas condiciones clínicas, se limitan al desarrollo de hiperglucemia, cataratas y aumento transitorio de peso.

Palabras clave:
Artritis reumatoide
Glucocorticoides
Fármacos modificadores de enfermedad

Glucocorticoids (GC) are a mainstay of the therapy in rheumatoid arthritis (RA). Currently, and despite their extensive use, the discussion about the benefits and adverse effects of low dose GC in the management of RA persists. In recent years, a number of clinical trials have attempted to establish the benefits of long-term GC use as a disease-modifying antirheumatic drug in RA, and to define their side effects. Results of these clinical trials provide solid evidence that low-dose GC can inhibit radiographic damage in early RA, and that side effects of GC, when used in that clinical framework, are limited to hyperglycaemia, cataracts, and transient weight gain.

Key words:
Rheumatoid arthritis
Glucocorticosteroids
Disease-modifying anti-rheumatic drugs
El Texto completo está disponible en PDF
Bibliografía
[1.]
Joint Committee of the Medical Research Council and Nuffield Foundation on clinical trials of cortisone, ACTH and other therapeutic measures in chronic rheumatic diseases.
A comparison of cortisone and aspirin in the treatment of early cases of rheumatoid arthritis.
Br Med J, 29 (1954), pp. 1223-1227
[2.]
Joint Committee of the Medical Research Council and Nuffield Foundation on clinical trials of cortisone, ACTH and other therapeutic measures in chronic rheumatic diseases.
A comparison of prednisolone with aspirin or other analgesics in the treatment of rheumatoid arthritis.
Ann Rheum Dis, 18 (1959), pp. 173-188
[3.]
E.D. Harris Jr, R.D. Emkey, J.E. Nichols, A. Newberg.
Low dose prednisone therapy in rheumatoid arthritis: a double blind study.
J Rheumatol, 10 (1983), pp. 713-721
[4.]
J.R. Kirwan.
The effect of glucocorticoids on joint destruction in rheumatoid arthritis.
N Engl J Med, 333 (1995), pp. 142-146
[5.]
P. Hickling, R.K. Jacoby, J.R. Kirwan, and the Arthritis and Rheumatism Council Low Dose Glucocorticoid Study Group.
Joint destruction after glucocorticoids are withdrawn in early rheumatoid arthritis.
Br J Rheumatol, 37 (1998), pp. 930-936
[6.]
A.M. Van Gestel, R.F. Laan, C.J. Haagsma, L.B. Van de Putte, P.L. Van Riel.
Oral steroids as bridge therapy in rheumatoid arthritis patients starting with parenteral gold. A randomized double-blind placebo-controlled trial.
Br J Rheumatol, 34 (1995), pp. 347-351
[7.]
K.G. Saag, L.A. Criswell, K.M. Sems, M.D. Nettleman, S. Kolluri.
Low-dose corticosteroids in rheumatoid arthritis. A meta-analysis of their moderateterm effectiveness.
Arthritis Rheum, 39 (1996), pp. 1818-1825
[8.]
M. Boers, A.C. Verhoeven, H.M. Markusse, M.A. Van de Laar, R. Westhovens, J.C. Van Denderen, et al.
Randomised comparison of combined stepdown prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis.
[9.]
R.B. Landewe, M. Boers, A.C. Verhoeven, R. Westhovens, M.A. Van de Laar, H.M. Markusse, et al.
COBRA combination therapy in patients with early rheumatoid arthritis: long-term structural benefits of a brief intervention.
Arthritis Rheum, 46 (2002), pp. 347-356
[10.]
C.J. Haagsma, P.L. Van Riel, A.J. De Jong, L.B. Van de Putte.
Combination of sulphasalazine and methotrexate versus the single components in early rheumatoid arthritis: a randomized, controlled, double blind, 52 week clinical trial.
Br J Rheumatol, 36 (1997), pp. 1082-1088
[11.]
M. Dougados, B. Combe, A. Cantagrel, P. Goupille, P. Olive, M. Schattenkirchner, et al.
Combination therapy in early rheumatoid arthritis: a randomised, controlled, double blind 52 week clinical trial of sulphasalazine and methotrexate compared with the single components.
Ann Rheum Dis, 58 (1999), pp. 220-225
[12.]
J.F. Maillefert, B. Combe, P. Goupille, A. Cantagrel, M. Dougados.
Long term structural effects of combination therapy in patients with early rheumatoid arthritis: five year follow up of a prospective double blind controlled study.
Ann Rheum Dis, 62 (2003), pp. 764-766
[13.]
Y.P.M. Goekoop-Ruiterman, J.K. De Vries-Bouwstra, C.F. Allaart, D. Van Zeben, P.J.S.M. Kerstens, J.M.W. Hazes, et al.
Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study).
Arthritis Rheum, 52 (2005), pp. 3381-3390
[14.]
M. Hansen, J. Podenphant, A. Florescu, M. Stoltenberg, A. Borch, E. Kluger, et al.
A randomised trial of differenciated prednisolone treatment in active rheumatoid arthritis. Clinical benefits and skeletal side effects.
Ann Rheum Dis, 58 (1999), pp. 713-718
[15.]
H.E. Paulus, D. Di Primeo, M. Sanda, J.M. Lynch, B.A. Schwartz, J.T. Sharp, et al.
Progression of radiographic joint erosion during low dose corticosteroid treatment of rheumatoid arthritis.
J Rheumatol, 27 (2000), pp. 1632-1637
[16.]
R. Rau, S. Wassenberg, H. Zeidler.
Low dose prednisolone therapy (LDPT) retards radiographically detectable destruction in early rheumatoid arthritis.
Z Rheumatol, 59 (2000),
[17.]
H.K. Zeidler, T.K. Kvien, P. Hannoven, F.A. Wollheim, O. Forre, H. Geidel, et al.
Progression of joint damage in early active severe rheumatoid arthritis during 18 months of treatment: Comparison of low-dose cyclosporin and parenteral gold.
Br J Rheumatol, 37 (1998), pp. 847-882
[18.]
A.A. Van Everdingen, J.W.G. Jacobs, D.R. Siewertsz van Reesema, J.W.J. Bijlsma.
Low-dose prednisone therapy for patients with early active rheumatoid arthritis: Clinical efficacy, disease-modifying properties, and side effects.
Ann Intern Med, 136 (2002), pp. 1-12
[19.]
A.A. Van Everdingen, D.R. Siewertsz van Reesema, J.W.G. Jacobs, J.W.J. Bijlsma.
The clinical effect of glucocorticoids in patients with rheumatoid arthritis may be masked by decreased use of additional therapies.
Arthritis Rheum, 51 (2004), pp. 233-238
[20.]
J.W.G. Jacobs, A.A. Van Everdingen, M.M. Verstapen, J.W.J. Bijlsma.
Followup radiographic data on patients with rheumatoid arthritis who participated in a two-year trial of prednisone or placebo.
Arthritis Rheum, 54 (2006), pp. 1422-1428
[21.]
H.A. Capell, R. Madhok, J.A. Hunter, D. Porter, E. Morrison, J. Larkin, on behalf of the WOSERACT group, et al.
Lack of radiological and clinical benefit over two years of low dose prednisolone for rheumatoid arthritis: results of a randomised controlled trial.
Ann Rheum Dis, 63 (2004), pp. 797-803
[22.]
B. Svensson, A. Boonen, K. Albertsson, D. Van der Heijde, C. Keller, I. Hafström, For the BARFOT Study Group.
Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate.
Arthritis Rheum, 52 (2005), pp. 3360-3370
[23.]
S. Wassenberg, R. Rau, P. Steinfeld, H. Zeidler.
Very low-dose prednisolone in early rheumatoid arthritis retards radiographic progression over two years.
Arthritis Rheum, 52 (2005), pp. 3371-3380
[24.]
P.C. Gotzsche, H.K. Johansen.
Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis.
Cochrane Database Syst Rev, (2006), pp. 3
[25.]
J.W.J. Bijlsma, A.A. Van Everdingen, M. Huisman, R.N. De Nijs, J.W.G. Jacobs.
Glucocorticoids in rheumatoid arthritis. Effects on erosions and bone.
Ann NY Acad Sci, 966 (2002), pp. 82.90
[26.]
P.N. Sambrook, N.E. Lane.
Corticosteroid osteoporosis.
Best Pract Res Clin Rheumatol, 15 (2001), pp. 401-413
[27.]
M. Luengo, C. Picado, L. Del Río, N. Guañabens, J.M. Montserrat, J. Setoain.
Vertebral fractures in steroid dependent asthma and involutional osteoporosis: a comparative study.
Thorax, 46 (1991), pp. 803-806
[28.]
N.F.A. Peel, D.J. Moore, N.A. Barrington, D.E. Bax, R. Eastell.
Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis.
Ann Rheum Dis, 54 (1995), pp. 801-806
[29.]
T.P. Van Staa, H.G.M. Leufkens, L. Abenhaim, B. Zhang, C. Cooper.
Oral corticosteroids and fracture risk: relationship to daily and cumulative doses.
Rheumatology, 39 (2000), pp. 1383-1389
[30.]
R.N. De Nijs, J.W. Jacobs, J.W. Bijlsma, W.F. Lems, R.F. Laan, H.H. Houben, et al.
Prevalence of vertebral deformities and symptomatic vertebral fractures in corticosteroid treated patients with rheumatoid arthritis.
Rheumatology (Oxford), 40 (2001), pp. 1375-1383
[31.]
K.G. Saag, R. Koehnke, J.R. Caldwell, R. Brasington, L.F. Burmeister, B. Zimmerman, et al.
Low dose long-term corticosteroid therapy in rheumatoid arthritis: An analysis of serious adverse events.
Am J Med, 96 (1994), pp. 115-123
[32.]
D.M. Reid, C. Cooper, J.R. Kirwan.
Effects of corticosteroids on bone mass over two years when used in the management of early rheumatoid arthritis.
Br J Rheum, 35 (1996), pp. 210
[33.]
A.C. Verhoeven, M. Boers.
Limited bone loss due to corticosteroids: A systematic review of prospective studies in rheumatoid arthritis and other diseases.
J Rheumatol, 24 (1997), pp. 1495-1503
[34.]
J.A.P. Da Silva, J.W.G. Jacobs, J.R. Kirwan, M. Boers, K.G. Saag, L.B.S. Inês, et al.
Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data.
Ann Rheum Dis, 65 (2006), pp. 285-293
[35.]
J.W.J. Bijlsma, M. Boers, K.G. Saag, D.E. Furst.
Glucocorticoids in the treatment of early and late RA.
Ann Rheum Dis, 62 (2003), pp. 1033-1037
[36.]
S.S. Yeap, D.J. Hosking.
Management of corticosteroid-induced osteoporosis.
Rheumatology (Oxford), 41 (2002), pp. 1088-1094
[37.]
ACR.
Recommendations for the prevention and treatment of glucocorticoid- induced osteoporosis: 2001 update. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis.
[37.]
A.E. Stuck, C.E. Minder, F.J. Frey.
Risk of infectious complications in patients taking glucocorticosteroids.
Rev Infect Dis, 11 (1989), pp. 954-963
[39.]
H.O. Conn, T. Poynard.
Corticosteroids and peptic ulcer: a meta-analysis of adverse events during steroid therapy.
J Intern Med, 236 (1994), pp. 619-632
[40.]
J.M. Piper, W.A. Ray, J.R. Daugherty, M.R. Griffin.
Corticosteroid use and peptic ulcer disease: role of non-steroidal antiinflamatory drugs.
Ann Intern Med, 114 (1991), pp. 735-740
[41.]
L.A. García-Rodríguez, S. Hernández-Díaz.
The risk of upper gastrointestinal complications associated with nonsteroidal anti-inflamatory drugs, glucocortioids, acetaminophen, and combinations of these agents.
Arthritis Res, 3 (2001), pp. 98-101
[42.]
J.H. Gurwitz, R.L. Bohn, F.J. Glynn, M. Monane, H. Mogun, J. Avorn.
Glucocorticoids and the risk for initiation of hypoglycemic therapy.
Arch Intern Med, 154 (1994), pp. 97-101
[43.]
R. McDougall, J. Sibley, M. Haga, A. Russell.
Outcome in patients with rheumatoid arthritis receiving prednisone compared to matched controls.
J Rheumatol, 21 (1994), pp. 1207-1213
[44.]
L. Wei, T.M. MacDonald, B.R. Walker.
Taking glucocorticoids by precription is associated with subsequent cardiovascular disease.
Ann Intern Med, 141 (2004), pp. 764-770
[45.]
M. Boers, M.T. Nurmohamed, C.J.A. Doelman, L.R. Lard, A.C. Verhoeven, A.E. Voskuyl, et al.
Influence of glucocorticoids and disease activity on total and high density lipoprotein cholesterol in patients with rheumatoid arthritis.
Ann Rheum Dis, 62 (2003), pp. 842-845
[46.]
S. Wallberg-Jonsson, H. Johansson, M.L. Ohman, S. Rantapaa-Dahlqvist.
Extent of inflammation predicts cardiovascular disease and overall mortality in seropositive rheumatoid arthritis. A retrospective cohort study from disease onset.
J Rheumatol, 26 (1999), pp. 2562-2571
Copyright © 2007. Elsevier España S.L Barcelona
Idiomas
Reumatología Clínica

Suscríbase a la newsletter

Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?