Early recognition, prevention, and management of glucocorticoid toxicity in patients with rheumatic diseases.

INTRODUCTION: Glucocorticoids (GCs) are the mainstay treatment for acute and chronic rheumatic diseases. However, several treatment guidelines recommend limited use of GCs due to their associated toxicity. Rheumatic diseases, including rheumatoid arthritis, vasculitis, and polymyalgia rheumatica, often entail prolonged GC treatment, which may lead to major GC-related adverse events (AEs), such as osteoporosis, fracture, hyperglycemia, infection, and weight gain, along with cardiovascular, ophthalmic, and psychiatric-related AEs. AREAS COVERED: This review elaborates on common GC-associated toxicities, the requirement of baseline assessment of patients before GC initiation, and the use of steroid-sparing agents. It also indicates differences in GC-prescribing patterns between primary care physicians (PCPs) and specialists, highlighting referral delay challenges for suspected rheumatic disease cases. EXPERT OPINION: Treatment guidelines recommend baseline assessment and continuous monitoring of patients prescribed long-term GC treatment. In patients with rheumatic diseases, different risk contributing factors are responsible for GC-related AEs and are found to be dependent on dose and duration. GC therapies are an integral part of managing rheumatic diseases; however, inclusion of steroid-sparing alternative therapies could help reduce the long-term GC toxicity burden. Early referral and good communication between PCPs and specialists play an important role in reducing the long-term GC treatment burden.