Methylprednisolone dose titration in rheumatology: current clinical algorithms, monitoring, and strategies to minimize glucocorticoid burden
Summary. The paper systematizes current evidence-based approaches to methylprednisolone dose titration in rheumatology practice, accounting for the stepwise reduction of glucocorticoid (GC) therapy, clinical and laboratory monitoring of disease activity, and the prevention of GC-induced complications. The pathophysiological mechanisms of hypothalamic-pituitary-adrenal axis suppression and their clinical significance in the development of withdrawal syndrome and secondary adrenal insufficiency are reviewed. Current recommendations on the «treat-to-target» strategy are summarized, focusing on minimizing the cumulative GC burden in rheumatoid arthritis, systemic lupus erythematosus, and ANCA-associated vasculitis. The rationale for a differentiated approach to dose reduction based on therapeutic phases is substantiated, with particular emphasis on the transitional and physiological dose ranges where precise GC microtitration is required. A clinically oriented algorithm is proposed to differentiate between baseline disease relapse, GC withdrawal syndrome, and adrenal insufficiency, thereby optimizing treatment safety and reducing the risk of iatrogenic complications.
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