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The goal of glucocorticoid treatment in patients with rheumatoid arthritis (RA) is to use the lowest possible steroid dose that alleviates symptoms. But even low doses of prednisone (<5 mg/day) impart risk for skin fragility, glaucoma, cataracts, and excess infections (NEJM JW Gen Med May 15 2018 and J Rheumatol 2018; 45:320). In this study, researchers used two databases to identify adults with RA who had received disease-modifying antirheumatic drugs (DMARDs) for ≥6 months. Patients were categorized by daily glucocorticoid dose (none, <5 mg, 5−10 mg, and >10 mg).
Among 172,000 Medicare patients, 1-year cumulative incidence of hospitalized infections for patients who were not receiving glucocorticoids was 8.6%; incidences were 11.0%, 14.4%,…