#4-56E. Rethinking Glucocorticoids: Navigating Safe Low-Dose Strategies in Rheumatic Diseases (Lancet Rheumatol, 2026)

Are you struggling with glucocorticoid tapering and discontinuation in your daily rheumatology practice? This episode delves into a comprehensive review discussing the significant gap between current clinical guidelines and real-world practice regarding glucocorticoid treatment in inflammatory rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, and polymyalgia rheumatica. A pivotal finding from this research suggests that long-term maintenance on very low-dose glucocorticoids—specifically 5 mg or less per day—is generally acceptable and does not substantially increase the risk of major adverse events. However, when critically appraising these findings, clinicians must consider the potential for residual confounding, particularly how underlying disease activity acts as a major confounder affecting both risk assessment and treatment outcomes. For physicians, this review is highly relevant as it provides a safe, realistic, and practical strategy for managing difficult-to-treat patients who cannot easily discontinue steroids, ultimately helping to balance therapeutic efficacy with the mitigation of cumulative toxicities in everyday clinical settings.

Citation: Buttgereit F, Tam L-S. Glucocorticoid treatment in patients with inflammatory rheumatic diseases: current practice and open questions. Lancet Rheumatology. 2026. DOI: 10.1016/S2665-9913(26)00072-X15

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.