The impact of glucocorticoid treatment on health-related quality of life in children with rheumatic diseases: a scoping review

Glucocorticoid (GC) medications are commonly used in the treatment of moderate and severe rheumatic diseases (RD) in children. Long-term GC treatment is associated with frequent adverse effects. The health-related quality of life (HRQOL) impact of long-term GC treatment in children with RD is an important patient outcome to study, as treatment may be associated with long-term adverse drug reactions (ADRs) such as osteoporosis, obesity, and poor psychosocial health. To summarize current evidence on the impact of long-term systemic GC treatment on HRQOL in children with RD. We conducted a scoping review using a PRISMA-ScR protocol to evaluate the HRQOL of children with RD including juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (c-SLE), and juvenile dermatomyositis (JDM) treated with prednisone, prednisolone or intravenous methylprednisolone. We searched MEDLINE, EMBASE, APA, CINAHL, Web of Science, and Cochrane Central of Controlled Trials from inception to May 2022. The search was subsequently updated from May 2022 to August 2025, and newly identified records were screened using Covidence following the same eligibility criteria. We used the PRISMA-ScR checklist to develop the protocol for data charting, appraisal, and synthesis. The Quality In Prognosis Studies (QUIPS) tool was used for the critical appraisal of studies. 541 records were retrieved, of which 7 studies were eligible for inclusion. Most studies were cross-sectional analytical studies (6). and one prospective cohort study. Three studies reported lower HRQOL for patients with childhood rheumatic diseases on long-term GC, including impacts related to physical appearance changes and obesity. In addition, deficits in emotional functioning, such as anxiety, were described by 2 studies. Longer courses and higher doses of GC treatment were associated with greater frequency of side effects and more disease-related damage, especially when treatment extended beyond 5 years. Patients reported that GC-related adverse effects were important factors to consider in their treatment. GC treatment was associated with specific emotional HRQOL outcomes in some studies, but showed no consistent association with overall changes in HRQOL, with at least one study reporting improvement. Whether HRQOL differences reflect GC treatment, or underlying disease activity remains unclear, underscoring the need for standardized HRQOL measures in future research.