[Use of glucocorticoids in rheumatoid arthritis. Inhibition of disease progression versus risk of steroid osteoporosis].
This is a short overview of low dose oral treatment with 5-7.5 mg prednisolone/day in RA with emphasis on radiographic progression. Short-term studies over 1-2 weeks with 7.5-15 mg prednisolone/day demonstrate advantage over placebo and--less so--over NSAID in improving RA symptoms; over 6-12 months prednisolone seems to be less superior. Older studies were unable to demonstrate an inhibition of progression seen on radiographs. In the Kirwan study, there was a significant inhibition of x-ray progression with 7.5 mg prednisolone/day versus placebo. The German low-dose prednisolone treatment (LDPT) study demonstrated a significant retardation of radiographic progression with only 5 mg prednisolone/day in addition to DMARD treatment with parenteral gold or methotrexate versus DMARD + placebo in early RA during the first year of treatment while there was no difference between both groups during the second year. These data are in favor of a "bridging" treatment with low dose prednisolone. The risks of corticosteroid treatment are discussed, including an increased mortality rate as an independent risk factor. Two randomized studies and a metaanalysis indicate the development of steroid osteoporosis in RA already with low doses. As with every treatment, benefit and risk have to be considered carefully.
Rau
R
R
Evangelisches Fachkrankenhaus Rheumatologische Klinik Rosenstrasse 2, 40882 Ratingen, Germany.
D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced*; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D012307:Risk Factors
D005938:Glucocorticoids; D011239:Prednisolone