LOW-DOSE CORTICOSTEROID-THERAPY IN RHEUMATOID-ARTHRITIS - BALANCING THE EVIDENCE

Corticosteroid (steroid) use is common but controversial in rheumatoid arthritis (RA). Some observational studies suggest that mortality mig ht be increased with steroid use, and several large retrospective revi ews indicate that longterm low-dose steroid use is a significant indep endent predictor of numerous, potentially serious adverse events. Both cumulative and average steroid dose are independent important adverse -event predictors. There is a lack of long-term data on the efficacy o f steroid therapy, since few studies exceed 1 year in follow-up. Most of the short-and medium-term steroid studies reveal similar or improve d disease activity when compared with control therapy. A meta-analysis of the few randomized studies available showed that steroids were equ ivalent or slightly better than placebo and active controls in improvi ng RA disease activity. Studies of disease-modifying effects have not produced definitive results. (C) 1997 by Excerpta Medica, Inc.