The evolution of glucocorticoid therapy: from historical observations to personalised rheumatology

The editors of the «Ukrainian rheumatological journal»

Summary. Glucocorticoids (GC) have remained one of the key therapeutic tools in rheumatology for over 75 years. From the first clinical use of cortisone in rheumatoid arthritis to modern strategies for the rational use of GC, significant scientific and clinical transformations have taken place. This article reviews the historical stages of development of glucocorticoid therapy, the evolution of ideas about mechanisms of action — from simple anti-inflammatory concepts to models of genomic and non-genomic effects — and their impact on efficacy and safety profile. Particular attention is paid to the pharmacological characteristics of various GCs and the practical aspects of drug selection, including the role of methylprednisolone as an agent with balanced mechanisms of action. Modern approaches to minimising cumulative doses, tapering strategies, and the possibility of personalised low-dose therapy in selected patients are also discussed. In conclusion, it is emphasised that, despite the emergence of biological and targeted drugs, GCs continue to play a significant role in the management of rheumatic patients, and their effective use in the future will be based on personalisation and risk-benefit optimisation.