Drug helps arthritis, but has side effects: study

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Thanks for this most timely article.

Debs

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Drug helps arthritis, but has side effects: study

NEW YORK, Dec 31 (Reuters Health) - Patients in the early stages of

rheumatoid arthritis may have less joint damage if they take the steroid

drug prednisone, according to the results of a study conducted in the

Netherlands. However, long-term use of the drug--even at relatively low

doses--appears to increase the risk of bone fractures, experts warn.

Rheumatoid arthritis is a disease in which the immune system attacks the

lining of joints, causing pain, stiffness and inflammation. The disease

can ultimately cause joint destruction and disability. The condition is

more common in women than in men and can be diagnosed in people in their

30s and 40s.

Corticosteroids, such as prednisone, are used to treat many conditions

such as arthritis, asthma and lupus, and taking them is known to cause

bone thinning.

Writing in the January issue of the journal ls of Internal Medicine,

Dr. Amalia A. van Everdingen and colleagues report the results of their

study on the use of prednisone to slow the progression of rheumatoid

arthritis. Other drugs are known to slow joint damage seen in rheumatoid

arthritis patients, and the researchers wanted to find out if prednisone

could be safely used in the same way.

In the study, the researchers prescribed 10 milligrams (mg) of

prednisone to 41 patients who were known to have rheumatoid arthritis

for less than one year. Forty other patients, who also had the condition

for less than one year received an inactive placebo.

After 6 months of treatment, those taking prednisone had less joint

stiffness, swelling and tenderness, and they were less likely to take

other medications such as nonsteroidal anti-inflammatory drugs compared

with those taking the placebo, the authors report. They also note that

x-rays showed less joint damage in those taking prednisone.

However, after 2 years, those taking prednisone were more likely to have

cracks in their spinal bones than those taking a placebo. Five patients

in the prednisone groups compared with two people in the placebo group

developed fractures in the small bones of their backs.

Low doses of the drug may be useful when combined with other drugs known

to slow the progression of the disease, van Everdingen and colleagues

conclude.

In an accompanying editorial, Dr. Theodore Pincus of Vanderbilt

University Medical Center in Nashville, Tennessee, and colleagues take

issue with the notion that 10 mg of prednisone should be considered

" low-dose. "

" A dosage of 10 mg per day may be regarded as 'intermediate' or even

'high' by some clinicians, including ourselves, " the editorialists

write.

" Prednisone, in doses of 5 mg or less, appears to provide considerable

clinical benefit to many, if not most, patients with rheumatoid

arthritis and seems well tolerated in many patients, " Pincus and

colleagues conclude.

SOURCE: ls of Internal Medicine 2002;136:1-12, 76-78.