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Am Fam Physician. 1998;58(2):554-561

Although corticosteroids are effective in the treatment of rheumatoid arthritis, concerns about their safety have limited their use to intermittent therapy for acute exacerbations. Gøtzsche and Johansen conducted a meta-analysis of randomized trials of oral prednisone in the treatment of rheumatoid arthritis to compare the short-term efficacy of oral prednisone with that of nonsteroidal anti-inflammatory drugs (NSAIDs) and placebo.

Data were gathered from all trials published since 1966 in which low-dose prednisone (up to 15 mg daily) was compared with NSAIDs or placebo in the treatment of rheumatoid arthritis. Of the 28 randomized trials, 10 studies were included in the meta-analysis. The 10 studies included predominantly women (mean age: 55 years) with rheumatoid arthritis of approximately six years' duration. Most of the studies used the criteria established by the American Rheumatism Association for the disease and tended to involve patients with severe joint disease as assessed by the number of tender joints. All but one of the studies were double blind, and eight used a crossover design.

Data from these studies revealed that prednisone was significantly better than placebo in relieving joint tenderness, reducing pain and improving grip strength. Prednisone was also significantly better than NSAIDs in producing relief of pain and tenderness. Although prednisone was superior to NSAID therapy in improving grip strength, the difference in grip strength between patients treated with steroids and those treated with NSAIDs was not statistically significant.

The trials provided limited information on adverse effects. Five of the studies did not report on side effects, and one study reported that no side effects occurred. Of the remaining four studies, one reported “subjective reactions” in two patients, one reported acute psychosis in one patient, and two studies found no side effects with short-term therapy.

The authors conclude that low-dose prednisone therapy may be used intermittently in patients with rheumatoid arthritis.

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