Advertisement

Drugs & Aging

, Volume 8, Issue 3, pp 157–161 | Cite as

Low Dose Corticosteroids in Early Rheumatoid Arthritis

Can These Drugs Slow Disease Progression?
  • John R. Kirwan
  • Keith K. T. Lim
Leading Article

Summary

The role of corticosteroids in treating rheumatoid arthritis is controversial, but recourse to the available evidence of efficacy should guide patient management decisions. Earlier evidence suggested that symptomatic control could be improved for periods of 6 to 12 months, but not longer, without increasing doses to unacceptably high levels. The effect of corticosteroids on joint destruction has been unclear.

Recent findings from a controlled clinical trial show that prednisolone 7.5 mg/day can significantly retard the rate of erosive progression in patients with relatively early disease (<2 years’ duration). These results have implications for both disease management and our understanding of the pathogenesis of joint destruction in rheumatoid arthritis.

Keywords

Rheumatoid Arthritis Prednisolone Adis International Limited Synovitis Joint Destruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Byron MA, Kirwan JR. Corticosteroids in rheumatoid arthritis: is a trial of their disease modifying’ potential feasible? Ann Rheum Dis 1986; 46: 171–3CrossRefGoogle Scholar
  2. 2.
    Kirwan JR, and the Arthritis and Rheumatism Council Low Dose Glucocorticoid Study Group. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. N Engl J Med 1995; 333: 142–6PubMedCrossRefGoogle Scholar
  3. 3.
    Hilliquin P, Menkes C-J. Evaluation and management: early and established disease. In: Klippel JH, Dieppe PA, editors. Rheumatology. London: Mosby Year-Book Europe, 1994: 3.13.1–3.13.14Google Scholar
  4. 4.
    Hench PS, Kendall EC, Slocumb CH, et al. Effects of a hormone of the adrenal cortex (17-hydroxy-11 dehydrocroticosterone: compound E) and of pituitary adrenocorticotrophic hormone on rheumatoid arthritis. Preliminary report. Proc Staff Meet Mayo Clin 1949; 24: 181–97PubMedGoogle Scholar
  5. 5.
    Joint Committee of the Medical Research Council and Nuffield Foundation. A comparison of cortisone and aspirin in the treatment of early cases of rheuatoid arthritis. BMJ 1954; 29: 1223–7CrossRefGoogle Scholar
  6. 6.
    Empire Rheumatism Council. Multi-centre controlled trial comparing cortisone acetate and acetyl salicylic in the long term treatment of rheumatoid arthritis. Ann Rheum Dis 1955; 14: 353–67CrossRefGoogle Scholar
  7. 7.
    Joint Committee of the Medical Research Council and Nuffield Foundation. A comparison of prednisolone with aspirin or other analgesics in the treatment of rheumatoid arthritis. Ann Rheum Dis 1960; 19: 331–7CrossRefGoogle Scholar
  8. 8.
    West HF. Rheumatoid arthritis. The relevance of clinical knowledge to research activities. Abstr World Med 1967; 41: 401–17Google Scholar
  9. 9.
    Berntsen CA, Freyberg RH. Rheumatoid patients after five or more years of glucocorticoid treatment: a comparative analysis of 183 cases. Ann Intern Med 1961; 54: 938–53Google Scholar
  10. 10.
    Leibling MR, Leib E, McLaughlin K. Pulse methyl-prednisolone therapy in rheumatoid arthritis. Ann Intern Med 1981; 94: 21–6Google Scholar
  11. 11.
    Harris Jr ED, Emkey RD, Nicholas JE, et al. Low dose prednisolone therapy in rheumatoid arthritis. A double blind study. J Rheumatol 1983; 10: 713–21PubMedGoogle Scholar
  12. 12.
    Million R, Poole P, Kellgren JH, et al. Long term study of management of rheumatoid arthritis. Lancet 1984; i: 812–6CrossRefGoogle Scholar
  13. 13.
    Hansen TM, Kryger P, Elling H, et al. Double blind placebo controlled trial of pulse treatment with methylprednisolone combined with disease modifying drugs in rheumatoid arthritis. BMJ 1990; 301: 268–70PubMedCrossRefGoogle Scholar
  14. 14.
    Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol 1977; 18: 481–91Google Scholar
  15. 15.
    Hall GM, Spector TD, Griffin AJ, et al. The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women. Arthr Rheum 1993; 36: 1510–6CrossRefGoogle Scholar
  16. 16.
    Bresnihan B, Mulherin D, FitzGerald O. Synovial pathology and articular erosions in rheumatoid arthritis. Rheumatol Eur 1995; 24 Suppl. 2: 158–60Google Scholar

Copyright information

© Adis International Limited 1996

Authors and Affiliations

  • John R. Kirwan
    • 1
  • Keith K. T. Lim
    • 1
  1. 1.Rheumatology Unit, University Department of MedicineBristol Royal InfirmaryBristolEngland

Personalised recommendations