Does Low Dose Prednisone Work For Rheumatoid Arthritis?

Rheumatoid arthritis is a chronic progressive autoimmune inflammatory disease that affects multiple organ systems, but the joints in particular. Rheumatoid arthritis also damages and erodes away the cartilage and bones in the affected joints. This erosion cannot be seen by physical examination and is measured by x-rays. More erosion on an x-ray usually means that the disease is progressing or worsening.

Glucocorticoids or corticosteroids such as prednisone are used by some arthritis patients to reduce inflammation and suppress immune system activity. Synthetic corticosteroids, like prednisone, are designed to mimic cortisol action in body. Cortisol is a natural corticosteroid produced by the adrenal glands.

Glucocorticoids have been shown to improve the symptoms of rheumatoid arthritis. There is some debate as to whether glucocorticoids can slow the progression of the disease.

There is also concern about the long term side effects, such as heart problems, when taking glucocorticoids.

Glucocorticoid use in rheumatoid arthritis (RA) is common. Two Cochrane Reviews have been published examining the short term clinical benefit of low dose glucocorticoids compared to non-steroidal anti-inflammatory drugs. They have demonstrated good short term and medium term clinical benefits. The possibility that glucocorticoids may have a "disease modifying" effect in RA, which would be seen by a reduction in the rate of radiological progression, has been suggested by several investigators.

The objectives of the current review was to evaluate glucocorticoid efficacy in inhibiting the progression of radiological damage in rheumatoid arthritis.

This summary of a Cochrane review presents what we know about the effect of low dose glucocorticoids, such as prednisone, on the progression of rheumatoid arthritis.

The studies that were reviewed looked at people who had rheumatoid for up to 2 years. Low doses of glucocorticoid pills were taken and usually with a disease-modifying anti-rheumatoid drug (DMARD).
X-rays were periodically used to assess the progression of joint erosion and other signs of joint damage. Of the studies which were reviewed, all but one concluded that glucocorticoids given along with standard arthritis treatments significantly reduced the rate of joint erosion in rheumatoid arthritis patients. It did not necessarily correlate with long-term improvement in function however.

Bottom line: In people with rheumatoid arthritis, low dose glucocorticoids reduce the progression of RA over a 1 one to two year period.

This benefit occurred in people already taking a disease-modifying anti-rheumatoid drug (DMARD) and therefore this benefit is over and above any benefits from the DMARDs.

These results were true in people that had rheumatoid arthritis for less than 2 years. It seems possible that glucocorticoids would have the same effect in people who have had rheumatoid for 3 to 4 years, but it is not known whether this is true in people who have had it for longer.

The evidence that glucocorticoids, given in addition to standard therapy, can substantially reduce the rate of erosion progression in rheumatoid arthritis is convincing. There is concern about potential long-term adverse reactions to glucocorticoid therapy, such as increased cardiovascular risk and osteoporosis.

(Kirwan JR, Bijlsma JWJ, Boers M, Shea BJ. Effects of glucocorticoids on radiological progression in rheumatoid arthritis. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD006356. DOI: 10.1002/14651858.CD006356).