Glucocorticoids and Joint Destruction in Rheumatoid Arthritis

Publisher Website
Google Scholar
Abstract
Kirwan et al. (July 20 issue)1 found that “in patients with early, active rheumatoid arthritis, prednisolone (7.5 mg daily) given for two years in addition to other treatments substantially reduced the rate of radiologically detected progression of disease.” Rheumatoid arthritis is a disease that lasts 20 to 25 years, and the ultimate goal of a therapeutic strategy is to reduce the cumulative pain, disability, side effects, economic impact, and mortality over the course of the illness. Long-term, prospective observational studies of prednisone use show very disquieting results. With the use of average prednisone doses (6.9 mg per day) similar to those given by Kirwan et al. and after adjustment for appropriate covariates, prednisone therapy is associated with markedly increased disability,2 a doubled risk of hospitalization for gastropathy due to nonsteroidal antiinflammatory drugs,3 and a twofold increase in standardized mortality rates.4 Quantitative estimation of side-effect (toxicity index) scores shows higher scores for prednisone than for nearly all other agents used to treat rheumatoid arthritis.5