The Use and Abuse of Steroids in Rheumatology

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Arthritis Research Campaign2004"The use and Abuse of Steroids in Rheumatology":Excerpt:Oral steroids are often used in rheumatoid arthritis for patients refractoryto other treatments and in the elderly, in whom they may be better toleratedthan NSAIDs. There has been debate as to whether steroids should beintroduced early in the course of the disease. Although some patientsbenefit symptomatically from the addition of low-dose oral prednisolone tosecond-line drug therapy, this improvement is not sustained beyond 6 to 9months. A significant rebound flare in disease activity as the dose istapered may prevent steroid withdrawal, resulting in concerns aboutlong-term toxicity. Kirwan (1995) has reported that the addition of low-doseprednisolone (7.5mg daily) to standard treatment in early, active rheumatoidarthritis slows radiological development and progression of erosions.However, we do not know if the potential benefits are maintained beyond thetreatment period, nor if they are outweighed by long-term side effects. Atpresent, there is insufficient evidence to warrant widespread prescriptionof steroids in early disease; further studies are awaited.http://www.arc.org.uk/about_arth/med_reports/series3/pp/6338/6338.htm