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Editorial
Observational studies on glucocorticoids are harmful!
  1. Maarten Boers
  1. Department of Epidemiology and Biostatistics; Amsterdam Rheumatology & Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Professor Maarten Boers; eb{at}vumc.nl

https://doi.org/10.1136/lupus-2017-000219

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    In this issue, Apostopoulos et al1 report yet another observational study on the association of glucocorticoid (GC) treatment with a bad outcome, in this case damage accrual in SLE. Unsurprisingly, the association is present, and ‘independent’ of potential confounders. Unsurprisingly, the authors argue for a causal relationship. So what is new, and why are studies such as these harmful?

    First, let me apologise for this cynical start, and stress that I am convinced this research has been performed with the best of intentions. However, strong language is needed because I think observational studies on GC are taking a very dangerous turn: where previously associations were sought with adverse outcomes ‘typically’ associated with GC exposure, now studies are emerging that seek associations with core disease outcomes: in this case SLE morbidity/damage, in other cases …

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