Effects of long term glucocorticoid therapy in rheumatoid arthritis

Journal/Book: Z Rheumatol 1999; 58: 304-305. 1999;

Abstract: J. R. Kirwan; Rheumatology Unit University of Bristol The prevalence of rheumatoid arthritis (RA) in Europe ranges from 1-3% (1). RA makes up to 25% of all referrals to Rheumatology clinics and 75% of follow up work (2). Much debate has focused on whether or not it is possible to modify the natural history of RA (3 4). This is a difficult question to answer because of the chronic variable nature of the disease. Glucocorticoids offer one avenue of treatment. However although used since 1948 there have been relatively few randomised controlled trials of glucocorticoids in RA. In the 1950's after several attempts to define their role the broad conclusion was that they have a powerful anti-inflammatory effect but this may not be prolonged for more than a year or so. A re-analysis (5) of early results (6 7) concluded there was a case for the disease modifying potential of corticosteroid therapy. It proposed the conduct of a new randomised double blind placebo controlled trial of glucocorticoids designed specifically to test the hypothesis that glucocorticoids can suppress erosive progression. The results of that study have since been published (8). This trial found a clear cut reduction in the rate of radiological progression of the disease a finding mirrored in a study employing a higher glucocorticoid dose (9). However symptomatic benefit was relatively short lived (several months). There was no deterioration in the patients clinical status when glucocorticoids were withdrawn but radiological progression re-commenced (10) (see Figure). One can conclude that a fixed daily low dose of prednisolone (7.5 mg) can reduce the rate of radiological progression over 2 years in patients with early RA who are taking concomitant treatment with other second line agents. ... le

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