GCs May Not Cause Flares Among Patients with Psoriatic Diseases

Guidance against prescribing systemic glucocorticoids to patients with psoriatic arthritis (PsA) and psoriasis may not be based on solid evidence, advises a systematic review published online ahead of print in the journal Rheumatology.

“The use of systemic glucocorticoids is traditionally discouraged in the treatment of PsA and psoriasis due to the risk of psoriatic flares,” wrote study lead author Nanette Vincken, MD, of University Medical Center Utrecht in the Netherlands, and colleagues. “However, despite this recommendation, systemic glucocorticoids are frequently prescribed for these patients.”

The review included 11 retrospective and prospective cohorts that involved than 4.1 million patients. Despite current guidelines against their use, systemic glucocorticoids were prescribed frequently. Some 37.82% of patients with PsA and 35.17% of patients with psoriasis were treated with a systemic glucocorticoid, according to the review. Ten observational and interventional studies did not report elevated risk or occurrence of psoriatic flares associated with systemic glucocorticoid use.

“By the extent of systemic glucocorticoid usage, one would assume that the reported prevalence of systemic glucocorticoid-related psoriatic flares would be much higher,” researchers wrote. “Clinically, this is not the case.”

Evidence against systemic glucocorticoid use in patients with psoriasis and PsA tends to stem from case reports or case series, which carry a high risk of bias and low-quality evidence, researchers observed. They suggested that prospective studies are needed to assess the actual risk of flare.

“Considering how frequently systemic glucocorticoids are being prescribed, the occurrence of psoriatic flares appears low and is only related to mild skin flaring, so we feel that systemic glucocorticoids should not be withheld for the treatment of PsA/psoriasis patients when necessary,” the authors wrote. “In patients with a clear indication for systemic glucocorticoids use, eg those in need of rapid anti-inflammatory therapy or bridging of therapies, systemic glucocorticoids should be considered in view of the low risk of skin flaring.”

—Jolynn Tumolo

Reference:
Vincken NLA, Balak DMW, Knulst AC, Welsing PMJ, van Laar JM. Systemic glucocorticoid use and the occurrence of flares in psoriatic arthritis and psoriasis: a systematic review. Rheumatology (Oxford). Published online March 14, 2022. DOI: doi.org/10.1093/rheumatology/keac129