Glucocorticoids and Infections in Rheumatology

Glucocorticoids (GCs) are widespread anti-inflammatory drugs used in medical practice. The immunosuppressive effect of systemic GCs and increased susceptibility to infections are well known. Randomized controlled trials of the use of GCs in low doses and in short periods, as a rule, did not reveal an increased risk of comorbid infections (CI) or even showed its absence. However, observational studies in real clinical practice consistently demonstrate a dose-dependent increase in the risk of serious CI, including opportunistic ones (pneumocystis pneumonia, shingles, and tuberculosis). The review presents the main immunological effects of GCs that increase susceptibility to CI. The risks of CI in patients with immune-mediated inflammatory rheumatic diseases (IIRDs) receiving GCs were analyzed, taking into account the effect of doses, the duration of their use in combination with biological factors of the macro-organism, as well as concomitant immunosuppressive therapy. Physicians should actively evaluate the benefit-risk ratio of systemic GCs in patients with IIRD and take preventive measures to prevent infectious complications.

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