DEXAMETHASONE IS AN "ESSENTIAL, MEDICINE". IT IS TIME TO CONSIDER THIS DRUG IN THE TREATMENT OF RHEUMATIC DISEASES. A NARRATIVE REVIEW

Dexamethasone (DEX) is a synthetic clinical compound with potent glucocorticoid activity included by OMS in the essential medicines list in 2017, a basic health-care system indicating the most efficacious, safe and cost-effective medicines for priority conditions. DEX is widely used in clinical practice for many inflammatory conditions but it is not commonly accepted for treating rheumatic diseases (RDs). Aim of this review is to focus on the literature describing the efficacy and safety of DEX in the chronic and acute treatment of RDs, both in experimental and clinical settings, comparing DEX with other corticosteroids most used in reumathology. An outline of DEX mode of action on nociception and inflammation is also described. As shown by most recent literature, DEX is as effective as other glucocorticoids (GCs) for intra-articular treatment, but with less local and general side effects. Concerning chronic therapies, DEX shows a negligible mineral corticoid activity if compared with other GCs, while retaining a higher glucocorticoid activity and a strong anti-inflammatory effect, with a very high rapidity of action. Thus, experimental and clinical data show DEX efficacy and safety in managing both acute and chronic pain in RDs, through very rapid direct effects on inflammation mediators and nociceptive neurons. Besides, DEX shows a very high glucocorticoid potency at low dosages, leading to immunosuppression and persistent inhibition of nociception in long term therapies, with minor side effects. For these reasons, DEX represents a valid therapeutic option for RDs associated pain and chronic inflammation, alone or in combination with Disease Modifying Antirheumatic Drugs, also allowing to reduce the use of opioids in post-operative care and acute episodes.