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Observational studies on glucocorticoids are harmful!
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  • Diane Apostolopoulos, Mandana Nikpour, Alberta Hoi and Eric F Morand
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    Response to Editorial
    • Diane Apostolopoulos, Rheumatologist Monash University
    • Other Contributors:
      • Mandana Nikpour, Rheumatologist
      • Alberta Hoi, Rheumatologist
      • Eric F Morand, Rheumatologist

    The Editor,
    Lupus Science and Medicine
    BMJ Journals

    Dear Madam/Sir,

    Our esteemed peer Dr. Boers has editorialised1 on our recently published study of associations of glucocorticoid use with damage accrual in SLE2, suggesting that studies of the type reported are ‘harmful’. As this is such a serious accusation, we feel compelled to respond, even though we suspect that in the end the views of the authors and of Dr Boers as serious physician-researchers are in fact highly aligned. Essentially, we do not resile from our view that long-term reliance on glucocorticoids for the control of inflammation in SLE carries harm, and that steroid-reducing regimens for SLE management are urgently needed. At no time in our report, and certainly not in our clinical practice, do we advise against the use of these drugs, though such an imprecation was implied (incorrectly) in Dr Boers’ editorial. Rather, it is our view that strategies to achieve control of disease activity with reduced reliance on glucocorticoids, such as improving the use of non-glucocorticoid agents or the introduction of novel therapies, are as urgently needed as ever – and that complacency about the chronic use of glucocorticoids in SLE is not an acceptable status quo.

    As we stated in the opening remarks, ‘The objective of the present study was to quantify damage accrual in a prospectively followed cohort of patients with SLE and determine the association of glucocorticoid use with damage...

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    Conflict of Interest:
    None declared.