SPECIAL COMMENTARIESThe safety of glucocorticoids in the treatment of inflammatory rheumatic disease: new evidenceLuís, Marianaa,b; Boers, Maartenc,d; Saag, Kene; Buttgereit, Frankf; da Silva, José A.P.a,b,g Author Information aRheumatology Department, Centra Hospitalar e Universitário de Coimbra bFaculty of Medicine, University of Coimbra, Coimbra, Portugal cDepartment of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam dAmsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands eDivision of Clinical Immunology and Rheumatology, Center for Education and Research on Therapeutics University of Alabama at Birmingham, Birmingham, Alabama, USA fDepartment of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany gCoimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal Correspondence to José A.P. da Silva, Rheumatology Department, Centra Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal. Tel: +351 239 400 547; e-mail: [email protected] Current Opinion in Rheumatology 34(3):p 179-186, May 2022. | DOI: 10.1097/BOR.0000000000000870 Buy Metrics Abstract Purpose of review Glucocorticoids justifiably remain a cornerstone in the treatment of many inflammatory rheumatic diseases but many are opposed to their use because of the side effects, most of them known to be dose-dependent. Most concerns regarding glucocorticoids stem from observational studies which are affected by several forms of bias, mainly confounding by indication, that may result in overestimation of harm. Solid evidence regarding the safety of low-dose glucocorticoids remains remarkably scarce. Recent findings Several observational studies showed heterogeneous results and two 6-month trials showed no increase of harm. The GLORIA trial of 5 mg/day prednisolone vs. placebo in patients aged 65+ is the first randomized control trial with glucocorticoids safety as coprimary outcome. The benefits of glucocorticoids in terms of symptoms and structural damage were confirmed, but the proportion of patients with at least one adverse event of special interest (serious or glucocorticoids-related) was increased by 24%, mostly due to nonsevere infections. Summary Based on current evidence the benefit–risk balance of low-dose glucocorticoids in rheumatoid arthritis, and probably in other rheumatic diseases is generally favourable. Physicians should be aware of the risks and mitigate them, but avoid the negative effects of unfounded fear. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.