Posterior Subcapsular Cataract In Rheumatoid Arthritis Patients After Long-Term, Low-Dosage Paramethasone Therapy

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Abstract
Posterior subcapsular cataract (PSC) was diagnosed in 9 out of 130 consecutive cases of rheumatoid arthritis. Seven of the 9 PSC patients had been treated with paramethasone, at least for some period of time. All the PSC patients had had long-term continuous corticosteroid therapy with total doses equal to or greater than 3 550 mg (mean 10 840 mg) prednisolone. All the patients in the material with a minimum total dose of 3 550 mg were analysed with respect to the various types of corticosteroids employed. Only 2 of 17 non-cataract patients had received paramethasone. Prednisolone was the commonest type of steroid in these patients. Two patients with non-PSC cataracts had been treated with paramethasone. The difference in the prevalence of PSC between the patients treated and those not treated with paramethasone is highly significant (p< 0.005) if the 2 patients with non-PSC cataract are excluded, and significant (p < 0.025) if the latter are included among the non-PSC patients. Moreover, an association between PSC and low-dosage therapy (< 10 prednisolone mg equivalent) was observed in the paramethasone-treated patients alone. The conclusions will be that paramethasone implies a greater risk of the complication PSC than does prednisolone in conventional equivalent doses and that there is a risk of PSC even at low-dosage paramethasone therapy, when administered continuously in rheumatoid arthritis for prolonged periods of time. Ragnhild Gullberg Department of Rheumatology Karolinska sjukhuset S-104 01 Stockholm Sweden