Plain language summary
Glucocorticoids for rheumatoid arthritis
This summary of a Cochrane review presents what we know from research about the effect of low dose glucocorticoid pills, such as prednisone, on the progress of rheumatoid arthritis. The review shows that:
In people with rheumatoid arthritis, low dose glucocorticoid pills:
- reduce the progression of the disease on x-rays over 1 to 2 years.
This result is based on high quality evidence.
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 likely 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 long term effects of glucocorticoids are not known.
What is rheumatoid arthritis and why use glucocorticoids?
Rheumatoid arthritis is a disease in which the body's immune system attacks its own healthy tissues. The attack happens mostly in the joints (especially in the hands and feet) and causes redness, pain, swelling and heat in the joint (inflammation). Glucocorticoids are also known as glucocorticosteroids, or sometimes just 'steroids', although there are many other types of steroids. They are taken as pills for up to 7 months and have already been shown to improve the symptoms of rheumatoid arthritis. There is however still some concern about the long term harms, such as heart problems, when taking glucocorticoids.
Rheumatoid arthritis also breaks down and erodes away the cartilage and bones in the affected joints. This erosion cannot be seen and is measured by x-rays. More erosion on an x-ray usually means that the disease is progressing or worsening. There is some debate about whether glucocorticoids can slow the erosion and the progression of the disease.
What are the effects of glucocorticoids on the progress of rheumatoid arthritis?
The studies 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).
Glucocorticoids reduce progression of the disease on x-rays over 1 to 2 years. This result is based on high quality evidence.
Harms were not reviewed. We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects and long term side effects. Low doses of glucocorticoids may not lead to side effects, but possible side effects may include osteoporosis or heart problems.