Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review

Inviewoftheuncertainty aboutsafelimits of steroid dosage andoftheparticular interest inthe 5mg.perdaydoselevel (deAndrade, McCormick, andHill, 1964), westudied adrenal cortical responsiveness ina series ofpatients withrheumatoid arthritis, whohadbeenonthisdoseofprednisone forvarying periods, bytheSynacthen test(Wood, Frankland, James, andLandon, 1965).

https://ard.bmj.com/content/annrheumdis/27/1/33.full.pdf

Plasma "cortisol" response to Synacthen in patients on long-term small-dose prednisone therapy.

Background: General recommendations for a reference case for economic studies in rheumatic diseases were published in 2002 in an initiative to improve the comparability of cost-effectiveness studies in the field. Since then, economic evaluations in osteoarthritis (OA) continue to show considerable heterogeneity in methodological approach. Objectives: To develop a reference case specific for economic studies in OA, including the standard optimal care, with which to judge new pharmacologic and non-pharmacologic interventions. Methods: Four subgroups of an ESCEO expert working group on economic assessments (13 experts representing diverse aspects of clinical research and/or economic evaluations) were charged with producing lists of recommendations that would potentially improve the comparability of economic analyses in OA: outcome measures, comparators, costs and methodology. These proposals were discussed and refined during a face-to-face meeting in 2013. They are presented here in the format of the recommendations of the recently published Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, so that an initiative on economic analysis methodology might be consolidated with an initiative on reporting standards. Results: Overall, three distinct reference cases are proposed, one for each hand, knee and hip OA; with diagnostic variations in the first two, giving rise to different treatment options: interphalangeal or thumbbased disease for hand OA and the presence or absence of joint malalignment for knee OA. A set of management strategies is proposed, which should be further evaluated to help establish a consensus on the “standard optimal care” in each proposed reference case. The recommendations on outcome measures, cost itemisation and methodological approaches are also provided. Conclusions: The ESCEO group proposes a set of disease-specific recommendations on the conduct and reporting of economic evaluations in OA that could help the standardisation and comparability of studies that evaluate therapeutic strategies of OA in terms of costs and effectiveness. & 2014 The Authors. Published by Elsevier HS Journals, Inc. This is an open access article under the CC BY-NCND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Goergenyi G

Papers

Adrenocortical and pituitary function following protracted prednisolone treatment