Re: RESEARCH - Lack of benefit over two years of low dose prednisolone for RA

[Guest guest]

Can we send this to every Rheumatologist in our nation?????? Maybe they

will use it with more caution.

As Jennie said, it¹s very useful to give a patient relief while waiting for

the meds to work, but the side effects are just to severe for long term.

It¹s unfortunate that so many members aren¹t able to get off of Prednisone

since they have been on it so long that their body no longer manufactures

it.

a

> ls of the Rheumatic Diseases 2004;63:797-803

>

> EXTENDED REPORT

>

>

> Lack of radiological and clinical benefit over two years of low dose

> prednisolone for rheumatoid arthritis: results of a randomised

> controlled trial

>

>

> H A Capell1, R Madhok1, J A Hunter3, D Porter3, E on4, J Larkin5,

> E A Thomson3, R Hampson1 and F W Poon2 on behalf of the WOSERACT Group*

>

> Background: Evidence for disease modifying activity of low dose

> corticosteroid treatment in rheumatoid arthritis is contradictory.

> Studies showing radiological benefit suggest that continued treatment is

> required to sustain the effect.

>

> Objective: To evaluate the effect of low dose oral prednisolone in early

> rheumatoid arthritis on disease activity over two years.

>

> Design: Double blind placebo controlled trial.

>

> Methods: Patients with rheumatoid arthritis, duration <3 years (n =

> 167), were started on a disease modifying antirheumatic drug (DMARD;

> sulphasalazine) and allocated by stratified randomisation to

> prednisolone 7 mg/day or placebo. Primary outcome measure was

> radiological damage, assessed by the modified Sharp method. Clinical

> benefit was a secondary outcome. A proactive approach to identifying and

> treating corticosteroid adverse events was adopted. Patients who

> discontinued sulphasalazine were offered an alternative DMARD.

>

> Results: 90 of 257 patients eligible for the study refused to

> participate (more women than men). Of those enrolled, 84% were

> seropositive for rheumatoid factor, median age 56 years, median disease

> duration 12 months, female to male ratio 1.8:1. Prednisolone was given

> to 84 patients; of these 73% continued prednisolone and 70%

> sulphasalazine at 2 years. Of the 83 patients on placebo, 80% continued

> placebo and 64% sulphasalazine at 2 years. There were no significant

> differences in radiological score or clinical and laboratory measures at

> 0 and 2 years.

>

> Conclusions: Low dose prednisolone conferred no radiological or clinical

> benefit on patients maintained on a DMARD over two years. Low dose

> corticosteroids have no role in the routine management of rheumatoid

> arthritis treated with conventional disease modifying drugs.

>

> http://ard.bmjjournals.com/cgi/content/abstract/63/7/797

>

>

>

>

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>

>

>

>

[Guest guest]

Can we send this to every Rheumatologist in our nation?????? Maybe they

will use it with more caution.

As Jennie said, it¹s very useful to give a patient relief while waiting for

the meds to work, but the side effects are just to severe for long term.

It¹s unfortunate that so many members aren¹t able to get off of Prednisone

since they have been on it so long that their body no longer manufactures

it.

a

> ls of the Rheumatic Diseases 2004;63:797-803

>

> EXTENDED REPORT

>

>

> Lack of radiological and clinical benefit over two years of low dose

> prednisolone for rheumatoid arthritis: results of a randomised

> controlled trial

>

>

> H A Capell1, R Madhok1, J A Hunter3, D Porter3, E on4, J Larkin5,

> E A Thomson3, R Hampson1 and F W Poon2 on behalf of the WOSERACT Group*

>

> Background: Evidence for disease modifying activity of low dose

> corticosteroid treatment in rheumatoid arthritis is contradictory.

> Studies showing radiological benefit suggest that continued treatment is

> required to sustain the effect.

>

> Objective: To evaluate the effect of low dose oral prednisolone in early

> rheumatoid arthritis on disease activity over two years.

>

> Design: Double blind placebo controlled trial.

>

> Methods: Patients with rheumatoid arthritis, duration <3 years (n =

> 167), were started on a disease modifying antirheumatic drug (DMARD;

> sulphasalazine) and allocated by stratified randomisation to

> prednisolone 7 mg/day or placebo. Primary outcome measure was

> radiological damage, assessed by the modified Sharp method. Clinical

> benefit was a secondary outcome. A proactive approach to identifying and

> treating corticosteroid adverse events was adopted. Patients who

> discontinued sulphasalazine were offered an alternative DMARD.

>

> Results: 90 of 257 patients eligible for the study refused to

> participate (more women than men). Of those enrolled, 84% were

> seropositive for rheumatoid factor, median age 56 years, median disease

> duration 12 months, female to male ratio 1.8:1. Prednisolone was given

> to 84 patients; of these 73% continued prednisolone and 70%

> sulphasalazine at 2 years. Of the 83 patients on placebo, 80% continued

> placebo and 64% sulphasalazine at 2 years. There were no significant

> differences in radiological score or clinical and laboratory measures at

> 0 and 2 years.

>

> Conclusions: Low dose prednisolone conferred no radiological or clinical

> benefit on patients maintained on a DMARD over two years. Low dose

> corticosteroids have no role in the routine management of rheumatoid

> arthritis treated with conventional disease modifying drugs.

>

> http://ard.bmjjournals.com/cgi/content/abstract/63/7/797

>

>

>

>

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>

>

>

>

[Guest guest]

I have a friend who has polymyalgia rheumatica and will have to be on

prednisone long term. Also, a man on my diabetes list had it and had to

take prednisone, even though it plays havoc with blood glucose. He went

on insulin and managed to get his dose of prednisone down to a low

level. a, is prednisone the only medication for that disease?

Sue

On Thursday, November 18, 2004, at 05:19 PM, a54 wrote:

>

> Can we send this to every Rheumatologist in our nation?????? Maybe

> they

> will use it with more caution.

> As Jennie said, it’s very useful to give a patient relief while

> waiting for

> the meds to work, but the side effects are just to severe for long

> term.

> It’s unfortunate that so many members aren’t able to get off of

> Prednisone

> since they have been on it so long that their body no longer

> manufactures

> it.

[Guest guest]

I have a friend who has polymyalgia rheumatica and will have to be on

prednisone long term. Also, a man on my diabetes list had it and had to

take prednisone, even though it plays havoc with blood glucose. He went

on insulin and managed to get his dose of prednisone down to a low

level. a, is prednisone the only medication for that disease?

Sue

On Thursday, November 18, 2004, at 05:19 PM, a54 wrote:

>

> Can we send this to every Rheumatologist in our nation?????? Maybe

> they

> will use it with more caution.

> As Jennie said, it’s very useful to give a patient relief while

> waiting for

> the meds to work, but the side effects are just to severe for long

> term.

> It’s unfortunate that so many members aren’t able to get off of

> Prednisone

> since they have been on it so long that their body no longer

> manufactures

> it.

[Guest guest]

The same anti-inflammatory drugs (NSAID's) used to treat RA are also used in

PM. Mild cases may be able to be controlled without prednisone. More

severe cases are treated with prednisone. The dose should be tapered down

to the lowest possible dose to control inflammation.

These 2 sites talk about prednison use in PM. They advocate weaning off of

prednisone:

http://www.arthritis.co.za/pmr.html

http://www.mayoclinic.com/invoke.cfm?objectid=F451920F-7F75-40AC-9B58A5817F1

06DFA & dsection=8

Has your friend tried any other NSAID's?

a

> I have a friend who has polymyalgia rheumatica and will have to be on

> prednisone long term. Also, a man on my diabetes list had it and had to

> take prednisone, even though it plays havoc with blood glucose. He went

> on insulin and managed to get his dose of prednisone down to a low

> level. a, is prednisone the only medication for that disease?

>

> Sue

[Guest guest]

The same anti-inflammatory drugs (NSAID's) used to treat RA are also used in

PM. Mild cases may be able to be controlled without prednisone. More

severe cases are treated with prednisone. The dose should be tapered down

to the lowest possible dose to control inflammation.

These 2 sites talk about prednison use in PM. They advocate weaning off of

prednisone:

http://www.arthritis.co.za/pmr.html

http://www.mayoclinic.com/invoke.cfm?objectid=F451920F-7F75-40AC-9B58A5817F1

06DFA & dsection=8

Has your friend tried any other NSAID's?

a

> I have a friend who has polymyalgia rheumatica and will have to be on

> prednisone long term. Also, a man on my diabetes list had it and had to

> take prednisone, even though it plays havoc with blood glucose. He went

> on insulin and managed to get his dose of prednisone down to a low

> level. a, is prednisone the only medication for that disease?

>

> Sue

[Guest guest]

Thanks, a, for the URL's. My friend has only been prescribed

prednisone. She does go to a rheumatologist, too. Sue

On Thursday, November 18, 2004, at 07:27 PM, a54 wrote:

>

> The same anti-inflammatory drugs (NSAID's) used to treat RA are also

> used in

> PM. Mild cases may be able to be controlled without prednisone. More

> severe cases are treated with prednisone. The dose should be tapered

> down

> to the lowest possible dose to control inflammation.

>

> These 2 sites talk about prednison use in PM. They advocate weaning

> off of

> prednisone:

>

> http://www.arthritis.co.za/pmr.html

>

> http://www.mayoclinic.com/invoke.cfm?objectid=F451920F-7F75-40AC-

> 9B58A5817F1

> 06DFA & dsection=8

>

> Has your friend tried any other NSAID's?

[Guest guest]

Thanks, a, for the URL's. My friend has only been prescribed

prednisone. She does go to a rheumatologist, too. Sue

On Thursday, November 18, 2004, at 07:27 PM, a54 wrote:

>

> The same anti-inflammatory drugs (NSAID's) used to treat RA are also

> used in

> PM. Mild cases may be able to be controlled without prednisone. More

> severe cases are treated with prednisone. The dose should be tapered

> down

> to the lowest possible dose to control inflammation.

>

> These 2 sites talk about prednison use in PM. They advocate weaning

> off of

> prednisone:

>

> http://www.arthritis.co.za/pmr.html

>

> http://www.mayoclinic.com/invoke.cfm?objectid=F451920F-7F75-40AC-

> 9B58A5817F1

> 06DFA & dsection=8

>

> Has your friend tried any other NSAID's?

[Guest guest]

You¹re welcome Sue. I hope your friend questions her doctor about

alternatives. If she¹s been on it for a long time, she may not have any

alternative. I hope it¹s possible for her to switch to a NSAID. If she has

to stay on prednisone, she may want to ask her doctor about what she can do

to prevent problems associated with long term steroid use.

a

> Thanks, a, for the URL's. My friend has only been prescribed

> prednisone. She does go to a rheumatologist, too. Sue

>

[Guest guest]

You¹re welcome Sue. I hope your friend questions her doctor about

alternatives. If she¹s been on it for a long time, she may not have any

alternative. I hope it¹s possible for her to switch to a NSAID. If she has

to stay on prednisone, she may want to ask her doctor about what she can do

to prevent problems associated with long term steroid use.

a

> Thanks, a, for the URL's. My friend has only been prescribed

> prednisone. She does go to a rheumatologist, too. Sue

>