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This typically indicates insufficient dosing, product quality issues, or advanced atrophy requiring higher stimulation

Long-term low-dose corticosteroids are common in RA, and any opportunity to reduce them is generally welcomed by both patients and rheumatologists because of the long-term side effects (bone density loss, blood sugar effects, infection risk)

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People taking medication to suppress the immune system after an organ transplant are also at higher risk

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ScienceDirect , Chopra, Sakshi, et al