REVIEW - Steroids in early RA

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Australian Family Physician

Vol 37, (1/2) 31 –32

January / February 2008

Glucocorticoids in early rheumatoid arthritis

Maureen Davey MBBS, MSc, FAFPHM, is a general practitioner and public

health physician, Hobart, Tasmania.

le Buchbinder MBBS(Hons), MSc, PhD, FRACP, is Director, Monash

Department of Clinical Epidemiology at Cabrini Hospital, Professor,

Department of Epidemiology and Preventive Medicine, Monash University,

and Joint Coordinating Editor, Cochrane Musculoskeletal Group.

Excerpt:

It is clear that low dose glucocorticoids do have a beneficial effect

in early RA through their ability to provide symptomatic relief and

reduction in joint damage. However, applying these results to clinical

practice is not straightforward as the Cochrane review only established

benefits and did not address risk.

There are still many unanswered questions about the use of low

dose glucocorticoids in RA, including the optimal dose and duration of

treatment and the true risks of adverse effects over the longer term.

People with RA are already at an increased risk of cardiovascular

disease and osteoporosis as a result of their disease. If oral

glucocorticoids are to be used, other drugs that increase steroid induced

gastrointestinal and cardiovascular toxicity such as NSAIDs should

be avoided. The difficulties in being able to withdraw even low dose

glucocorticoids in routine clinical practice – and the concomitant

risks associated with longer than planned use – should not be

underestimated. Furthermore, their value in long standing RA disease

is unknown and the benefits need to be carefully weighed against the

potential for harm in patients with or at risk for obesity, osteoporosis,

diabetes, hypertension, glaucoma and heart disease.

In view of the many unresolved issues, the use of low dose oral

glucocorticoids should be reserved for patients with severe active

RA and restricted to short term use. We strongly advise consultation

or discussion with a rheumatologist before commencement of oral

glucocorticoids for the treatment of RA.

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Read the entire article here:

http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys\

/2008issues/afp200801/200801davey.pdf

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Not an MD