A systematic review and meta-analysis: Effects of glucocorticoids on rheumatoid arthritis and systemic lupus erythematosus

Abstract

Background: Meta-analysis was performed to explore the efficacy of glucocorticoids in the treatment of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), to provide a theoretical basis for the clinical treatment of patients. Methods: Relevant literatures from the establishment of the database to December 31, 2020, were searched from databases such as PubMed. The literatures with randomized controlled trial of the clinical efficacy of glucocorticoids in the treatment of RA and SLE were screened for meta-analysis. Results: Eleven documents were included, including 1,298 participants. It was found that the cardiovascular system [mean difference (MD) =1.23; 95% confidence interval (CI): 0.64 to 2.34; Z=0.62; P=0.53], respiratory system (MD =1.87; 95% CI: −0.66 to 5.29; Z=1.18; P=0.24), nervous system (MD =1.22; 95% CI: 0.25–5.84; Z=0.25; P=0.8), visual impairment (MD =1.41; 95% CI: 0.79–2.52; Z=1.15; P=0.25), endocrine system (MD =8.53; 95% CI: 2.71–26.88; Z=3.66; P=0.0003), digestive system (MD =1.41; 95% CI: 0.76– 2.63; Z=1.09; P=0.28), genitourinary system (MD =1.06; 95% CI: 0.35–3.17; Z=0.1; P=0.92), blood system (MD =2.96; 95% CI: 0.62–14.26; Z=1.35; P=0.18), Z=0.48; P=0.63), infection status (MD =1.36; 95% CI: 0.98–1.87; Z=1.86; P=0.06), clinical efficacy (MD =1.79; 95% CI: 1.27–2.52; Z=3.32; P=0.0009), pain (MD =1.16; 95% CI: 0.76–1.78; Z=0.68; P=0.5), and joint swelling score (MD =0.03; 95% CI: −0.38 to 0.45; Z=0.15; P=0.88) of experimental group after treatment were all superior versus controls. However, the skin and mucous membranes (MD =0.87; 95% CI: 0.55–1.37; Z=0.61; P=0.54), musculoskeletal (MD =0.85; 95% CI: 0.43–1.66; Z=0.48; P=0.63), radiation injury (MD =−1.93; 95% CI: −3.68 to −0.18; Z=2.17; P=0.03), and C-reactive protein (CRP) level (MD =−8.66; 95% CI: −10.16 to −7.16; Z=11.34; P<0.00001) of experimental group were inferior to those of control group. Discussion: Glucocorticoids in the treatment of RA and SLE can improve the clinical efficacy, but it was easy to cause multiple system adverse reactions. Therefore, the clinical treatment should follow the doctor’s advice.