In a new study, researchers found rheumatoid arthritis drugs glucocorticoids are linked to an increased risk for infection, even at doses as low as 5 mg or less per day.
These findings are important, as low-dose glucocorticoids are generally considered safe and are widely prescribed.
They say doctors should consider this information when weighing the benefits and risks of glucocorticoid treatment for patients with rheumatoid arthritis.
The research was conducted by a team from the University of Pennsylvania.
Glucocorticoids are effective for the treatment of rheumatoid arthritis when added to disease-modifying antirheumatic drugs (DMARDs).
The goal is short-term use, yet up to 60% of patients with rheumatoid arthritis remain on long-term glucocorticoids, especially at low doses.
While the risk for infection at high doses is well-established, the risk with low-dose glucocorticoid therapy is less clear.
In the study, the team used claims data to study more than 200,000 patients with rheumatoid arthritis who had been receiving stable DMARDs, including biologics, for the preceding 6 months and then compared them to patients not receiving glucocorticoids.
They found that patients receiving higher dose glucocorticoids (>10 mg/day) had more than twice the risk of serious infection as patients not receiving glucocorticoids, although few patients were on these doses.
Even patients on the lowest dose had about a 30% increase in the risk of infection.
According to the team, glucocorticoids may continue to be an important part of treatment for many patients, especially if other treatments are not fully controlling their rheumatoid arthritis.
But these findings should help physicians better understand their potential risk.
One author of the study is Michael D. George, MD, MSCE.
The study is published in the Annals of Internal Medicine.
