Bolus Intramuscular Methylprednisolone Acetate as a Therapeutic Adjunct in Rheumatoid Arthritis

Kovarsky, Joel; Pegram, Samuel

doi:10.1097/00007611-198612000-00013

Cited by 4 publications

(2 citation statements)

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“…A summary of these groups is presented in Table 1 , while a condensed version of the data extraction table can be seen in Supplementary File 3 . There were thirteen RCTs [19] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] with random allocation and blinding maintained throughout; the remaining 60 studies were classified as observational studies [12] , [13] , [14] , [15] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] …”

Section: Resultsmentioning

confidence: 99%

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Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review

Joseph

Hunter

Ray

et al. 2016

Seminars in Arthritis and Rheumatism

147

119

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ObjectivesThe aim of this systematic literature review was to summarize the current knowledge regarding the prevalence of, time to recovery from, and influence of glucocorticoid dose and duration on glucocorticoid-induced adrenal insufficiency (AI).MethodsEligible studies were original research articles, which included adult patients with an indication for glucocorticoids and measured adrenal function following exposure to systemic glucocorticoids. Searches were performed in Web of Science and MEDLINE, with further articles identified from reference lists. Screening was performed in duplicate. Data were extracted for each group of glucocorticoid-exposed patients within eligible studies. The reported proportion of patients with AI was summarized as median and inter-quartile range. Results were then stratified by daily dose, cumulative dose, duration of exposure and time since last glucocorticoid use. The risk of bias within and across studies was considered: for randomised controlled trials risk of bias was assessed using the tool developed by the Cochrane Collaboration.ResultsOverall, 73 eligible studies were identified out of 673 screened. The percentage of patients with AI ranged from 0% to 100% with a median (IQR) = 37.4% (13–63%). Studies were small—median (IQR) group size 16 (9–38)—and heterogeneous in methodology. AI persisted in 15% of patients retested 3 years after glucocorticoid withdrawal. Results remained widely distributed following stratification. AI was demonstrated at <5 mg prednisolone equivalent dose/day, <4 weeks of exposure, cumulative dose <0.5 g, and following tapered withdrawal.ConclusionsThe heterogeneity of studies and variability in results make it difficult to answer the research questions with confidence based on the current literature. There is evidence of AI following low doses and short durations of glucocorticoids. Hence, clinicians should be vigilant for adrenal insufficiency at all degrees of glucocorticoid exposure.

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Section: Resultsmentioning

confidence: 99%

“…2 ). The number of patients retested ranged from 1 [61] , [89] to 48 [13] . Excluding the studies retesting a single patient, the percentage of patients with AI persisting at the end of follow-up ranged from 75% (after 10 weeks of cessation) [48] to 15% (after 3 years of cessation) [13] , [73] .…”

Section: Resultsmentioning

confidence: 99%

Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review

Joseph

Hunter

Ray

et al. 2016

Seminars in Arthritis and Rheumatism

147

119

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Efficacy of methylprednisolone pulse therapy in children with rheumatoid arthritis

2008

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Pulse therapy is one of the most well-known methods used in the treatment of juvenile rheumatoid arthritis. This study assessed the outcome of methylprednisolone pulse therapy, its rate of efficacy, and its associated complications in patients with juvenile rheumatoid arthritis (JRA). This cross-sectional study was performed on 120 children with JRA who attended the Pediatric Ward of Imam Khomeini Hospital from 1994 to 2004 and who had undergone around 500 cycles of methylprednisolone pulse therapies. Clinical signs, including signs of improvement, complications, or recurrence of disease, were noted. SPSS version 11.5 and paired t test were used to compare the variables prior to and after treatment. Clinical signs observed included: feeling of weakness (100%), malaise (98.3%), loss of appetite (93.3%), fever (88.3%), skin rash (28%), lymphadenopathy (18.3%), serositis (4.2%), splenomegaly (3.3%), and hepatomegaly (1.7%); however, none of these findings were present after pulse therapy. The number of swollen and tender joints, duration of morning stiffness, erythrocyte sedimentation rate, C-reactive protein, and hemoglobin levels showed significant improvement after pulse therapy. Complications of pulse therapy included tachycardia (n = 16, 13.3%), hypertension (n = 10, 8.3%), headache (n = 2, 1.7%), and flashing (n = 2, 1.7%). The mean duration of remission was 3.3 +/- 0.7 months.

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ORIGINAL ARTICLE, Deep Intramuscular Methylprednisolone Treatment of Recurrent Scleritis

Deokule

Saeed

Murray

2005

Ocular Immunology and Inflammation

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Bolus Intramuscular Methylprednisolone Acetate as a Therapeutic Adjunct in Rheumatoid Arthritis

Cited by 4 publications

References 0 publications

Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review

Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review

Efficacy of methylprednisolone pulse therapy in children with rheumatoid arthritis

ORIGINAL ARTICLE, Deep Intramuscular Methylprednisolone Treatment of Recurrent Scleritis

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