Low-dose steroids are neither safe nor effective for long-term treatment of RA

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Pharmaceutical ResearchLow-dose steroids are neither safe nor effective for long-term treatment ofrheumatoid arthritisDoctors should abandon the use of low-dose glucocorticoids such asprednisone as an antiquated approach to the treatment of rheumatoidarthritis (RA) in favor of more targeted and safer RA treatments, recommends G. Saag, M.D., M.Sc., in a recent commentary. He contends thatlong-term low-dose glucocorticoids, a type of steroid, simply do not work(their antiinflammatory benefits decline considerably after the first year),and they can cause undue adverse effects and toxicity. High on the list ofproblems is the dramatic bone loss and resulting fracture risk fromprolonged glucocorticoid use. Yet few RA patients are being evaluated andtreated for this potential complication.One study estimated that more than half of glucocorticoid users develop boneloss leading to fracture. Other studies have suggested a mean first-yearloss of bone of up to 15 percent at the dose range of 10 mg per day or lessof prednisone and up to a loss of 3 percent per year in subsequent years.Another study found that 34 percent of women on a mean dose of prednisone of8.6 mg per day had suffered a fracture within 5 years of followup.Cataract is another well-described complication of prolonged glucocorticoiduse. Cataract may develop even when inhaled glucocorticoids are used. Inaddition, increased intraocular pressure may develop in these patients,increasing the risk of glaucoma.Long-term use of low-dose glucocorticoids also may lead to development ofpremature atherosclerosis. One study found a three-fold increase inatherosclerosis in RA patients treated with glucocorticoids compared withnonsteroid-treated patients. Biologic response-modifying drugs are nowavailable to treat RA, such as methotrexate, leflunomide, etanercept, andinfliximab. When the serious problems associated with glucocorticoids areadequately explained, patients' perceptions of and preference for their usemay change markedly, says Dr. Saag. His work at the Center for Education andResearch on Therapeutics of Musculoskeletal Disorders, University of Alabamaat Birmingham, is supported in part by the Agency for Healthcare Researchand Quality (HS10389).More details are in "Resolved: Low-dose glucocorticoids are neither safe noreffective for the long-term treatment of rheumatoid arthritis," by Dr. Saag,in the October 2001 Arthritis Care & Research 45, pp. 468-471.http://www.ahcpr.gov/research/feb02/0202RA2.htm