Glucocorticoids in Spondyloarthritis-Systematic Review and Real-world Analysis

Rheumatology (Oxford). 2021 Mar 20;keab275. doi: 10.1093/rheumatology/keab275. Online ahead of print.

Abstract

Objective: To identify and summarise the efficacy and safety of systemic glucocorticoids (GC) and local injections of GC in spondyloarthritis (SpA).

Methods: PubMed (Medline) and EMBASE were searched with predefined keywords and relevant articles in English reporting RCTs, non-randomized and observational studies on efficacy of GC in SpA, with 5 or more patients, were included in the systematic literature review (SLR). Local injections of GC included intra-articular (IA) and entheseal injections, but excluded sacroiliac joint injections.

Results: Out of 9657 records, there were 14 studies on use of systemic GC in SpA (364 patients); including two RCTs of oral prednisolone. On pooling data from two placebo-controlled RCTs (≤ 24 weeks), BASDAI50 was 4.2 times more likely (95% CI 1.5 to 11.5) and ASAS 20 twice more likely (95% CI 1.1 to 3.64) to occur in patients on high-dose oral prednisolone (± taper). Pulse GC led to dramatic improvements that lasted a few weeks to a few months. There were no deaths or major AEs. There were 10 studies (560 patients) on local GC in SpA. IA injection were effective with sustained response in 51.5 to 90% joints at 6 months. Entheseal injections led to reduced pain and improved ultrasound parameters.

Conclusions: There were limited studies on both systemic and local injections of GC in SpA. However, there was good evidence of efficacy with use of high-dose systemic GC in the short term (≤ 6 months) in SpA. Intra-articular or entheseal injections seemed safe and effective.

Keywords: ankylosing spondylitis; corticosteroid; glucocorticoid; spondylarthritis; spondyloarthritis; steroid.