Low‐dose corticosteroids in rheumatoid arthritis. A meta‐analysis of their moderate‐term effectiveness

Abstract

Objective. To perform a systematic literature review and meta-analysis of the effectiveness of lowdose corticosteroids in the treatment of rheumatoid arthritis (RA).Methods. After identifying all relevant studies meeting preselected inclusion criteria, we performed 2 meta-analyses. First, we compared the effectiveness of prednisone to placebo and active drug controls (aspirin, chloroquine, or deflazacort) using standard metaanalysis methods for continuous data. Then, to compare the relative effectiveness of prednisone to second-line agents, we used methods similar to prior meta-analyses of second-line agents for RA treatment. Outcomes assessed were the number of tender and swollen joints, grip strength, and the erythrocyte sedimentation rate (ESR).Results. Very few studies directly assessed the effectiveness of corticosteroids for RA treatment, and many were of poor methodologic quality. Only 9 of 34 studies identified by our search met criteria for inclusion. The results of our standard meta-analysis indicated that corticosteroids appeared to be more effective than either placebo or active drug controls in improving most conventional outcome measures (effect size 0.90 for the number of tender joints, 1.05 for the number of swollen joints, and 1.20 for the ESR). In our second comparative meta-analysis, corticosteroids were nearly Submitted for publication January 9, 1996; accepted in revised form June 3, 1996. equivalent to second-line agents previously examined in meta-analyses (combined effect size 0.82).Conclusion. Based on the limited data available, during moderate-term treatment periods averaging slightly over 7 months, corticosteroids appeared to be as effective or more effective than alternative therapies in improving several common RA disease activity measures.

EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

“…[94][95][96][97][98][99] Results of a recent open study of 100 patients with undifferentiated arthritis suggested that a single dose of intramuscular or intra-articular steroids may even induce remission, 100 although formal evidence for this strategy is lacking.…”

Action of dexamethasone in the suppression of delayed-type hypersensitivity in reconstituted SCID mice

“…In addition, patients with RA have a lower density of glucocorticoid receptors in mononuclear cells compared to healthy controls [18]. These findings indicate that inherited defect in corticosteroid production and/or receptormediated uptake could increase the severity of RA and some rheumatologists recommend prednisone treatment to all patients with this diagnosis [19]. However, it is still not known if the corticosteroid-mediated amelioration of the inflammation in RA patients is exerted by a direct effect on the antigen presenting cells (APC) or T cells, or rather by action on other inflammatory cells and/or their products.…”

Resolved: Low‐dose prednisone is indicated as a standard treatment in patients with rheumatoid arthritis

“…After these studies, during the period from 1966 to 1994, only 9 studies comparing use of low-dose glucocorticoids with use of placebo or other active drugs in the treatment of RA were found to be suitable for meta-analysis (13). In the analysis of the treatment periods (averaging 7 months per study), glucocorticoids did prove to be as effective or more effective than alternative therapies in improving common rheumatoid disease measures.…”