Low doses of steroids can inhibit joint damage when used in the early phase of rheumatoid arthritis, according to a new review of evidence.
High-quality evidence supports combining the pills with standard medications in the first two years after diagnosis. “Such treatment should be made readily available to patients,” say review authors led by John Kirwan of Liverpool Women’s Hospital in England.
Concern exists about the side effects of steroid therapy, however. High doses can contribute to heart disease, osteoporosis and other complications. Questions remain about whether smaller doses lead to similar problems.
Rheumatoid arthritis is a chronic disease in which the body’s immune system attacks and destroys healthy joint tissue. The hands and feet are frequently affected, and as the disease progresses it can cause pain, swelling, deformity and disability.
The steroids studied in the review are known as glucocorticoids and include the well-known anti-inflammatory prednisone. This medication is often prescribed in the first few months after diagnosis to relieve the discomfort of RA until slower-acting drugs begin protecting the joints.
Until now, concerns about side effects caused most rheumatologists to “put people on the lowest possible dose of steroids and get them off it as soon as possible,” said Scott Zashin, M.D., of the University of Texas Southwestern Medical Center. “Now, we have to give steroids a little more respect.”
The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The systematic review is based on 15 studies including 1,414 patients. In most of the studies, patients received low doses of glucocorticoid pills along with so-called disease-modifying drugs for one to two years. Periodic X-rays revealed the extent of joint erosion and other signs of damage.
All studies except one showed reduced progression of joint damage in patients taking glucocorticoids. When reviewers used statistical methods to focus on only the highest-quality data, the benefits remained statistically significant.