Prednisone exhibits limited disease-modifying activity in early RA

NEW YORK (Reuters Health) – Findings from a Dutch study begun a decade ago show that low-dose prednisone monotherapy inhibits the progression of radiologic joint damage in patients with early active rheumatoid arthritis.

Adult rheumatoid arthritis patients presenting at two hospitals in the Netherlands between 1992 and 1995 with disease duration of less than 1 year were randomized to receive 10 mg prednisone or placebo q.d.

As reported in the January 1st issue of the Annals of Internal Medicine, Dr. Johannes W. G. Jacobs, of the University Medical Center Utrecht, and associates observed significant differences between the two groups at 24 months, primarily due to greater clinical improvement during the first 6 months in the prednisone group. For the 41 patients who took the steroid, grip strength and the 28-joint score for tenderness were significantly more improved at 24 months than they were for the 40 assigned placebo.

Prednisone-treated patients required 40% fewer intra-articular injections and 49% less paracetamol over the course of the study. In addition, between 12 and 24 months, radiologic scores progressed significantly less in the steroid-treated group. At 2 years, the modified Sharp scores were 16 and 29, respectively (p = 0.007), while radiologic scores were 27 and 44 (p = 0.02).

Adverse events included weight gain and increased mean serum glucose levels in the treatment group. Also, five patients given steroid versus two given placebo developed new vertebral fractures over the course of the study.

In an accompanying editorial, Dr. Theodore Pincus and associates of Vanderbilt University Medical Center in Nashville, Tennessee, laud the new insights provided in the Dutch study. Similar studies of this "old" therapy are unlikely to be repeated because of logistic and ethical considerations, they note.

The editorialists seem to agree with Dr. Jacobs et al in recommending that future studies combine the use of prednisone with more modern disease modifying therapies. Dr. Pincus' group also maintains that doses of the steroid lowered to more physiologic levels may be just as effective and not as damaging as the 10 mg used in the Dutch study.

Ann Intern Med 2002;136:1-12, 76-78.

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