Low-dose corticosteroids in rheumatoid arthritis. A meta-analysis of their moderate-term effectiveness



Objective. To perform a systematic literature review and meta-analysis of the effectiveness of low-dose corticosteroids in the treatment of rheumatoid arthritis (RA).

Methods. After identifying all relevant studies meeting preselected inclusion criteria, we performed 2 meta-analyses. First, we compared the effectiveness of prednisone to placebo and active drug controls (aspirin, chloroquine, or deflazacort) using standard meta-analysis methods for continuous data. Then, to compare the relative effectiveness of prednisone to second-line agents, we used methods similar to prior meta-analyses of second-line agents for RA treatment. Outcomes assessed were the number of tender and swollen joints, grip strength, and the erythrocyte sedimentation rate (ESR).

Results. Very few studies directly assessed the effectiveness of corticosteroids for RA treatment, and many were of poor methodologic quality. Only 9 of 34 studies identified by our search met criteria for inclusion. The results of our standard meta-analysis indicated that corticosteroids appeared to be more effective than either placebo or active drug controls in improving most conventional outcome measures (effect size 0.90 for the number of tender joints, 1.05 for the number of swollen joints, and 1.20 for the ESR). In our second comparative meta-analysis, corticosteroids were nearly equivalent to second-line agents previously examined in meta-analyses (combined effect size 0.82).

Conclusion. Based on the limited data available, during moderate-term treatment periods averaging slightly over 7 months, corticosteroids appeared to be as effective or more effective than alternative therapies in improving several common RA disease activity measures.