Article type
Year
Abstract
Introduction/Objective: To perform a systematic review of low-dose corticosteroid efficacy in the moderate term for the treatment of rheumatoid arthritis (RA).
Methods: We conducted a search in MEDLINE from 1966 to 1998, using the keywords "corticosteroids" and "rheumatoid arthritis". We also handsearched all issues of Arthritis and Rheumatism and the Scandinavian Journal of Rheumatology from their dates of first publication to 1994. Furthermore, we examined all Arthritis and Rheumatism abstracts over the 15 year period preceding 1994. References of all identified studies were searched for relevant trials. Authors of unpublished manuscripts were contacted. Studies were selected by two independent reviewers (LC, KS) using a set of predetermined criteria. We considered randomized controlled trials (RCTs) of at least three months duration that used prednisone (or a comparable corticosteroid preparation) at a mean dosage of less than or equal to 15 mg/day. Statistical Analysis: We compared the efficacy of prednisone to placebo and/or active controls using a fixed effects model for continuous data. A Chi Square test for homogeneity was performed, and where heterogeneity existed a random effects model was used.
Results: Only seven of 34 studies identified by our search met the criteria for inclusion. Our results indicated that corticosteroids were significantly more effective than placebo controls for four of six outcomes assessed [standardized mean difference (SMD) for JT = -0.37 (95%CI: -0.59, -0.14), JS = -0.41 (-0.67, -0.16), pain = -0.43 (-0.74, -0.12), and FS = -0.57 (-0.92, -0.22)]. The results for GS and ESR were not significant [GS = +0.30 (-0.19, +0.80), weighted mean difference (WMD) for ESR = -7.03 (-18.06, +4.01)]. The single trial that compared prednisone to aspirin indicated no statistically significant difference between these groups for the two outcomes assessed [SMD for JT = +0.10 (-0.35, +0.55), WMD for ESR = 0.00 (-11.09, +11.09)]. Overall, the four outcomes assessed in the trial that compared prednisone to chloroquine suggested that the effectiveness of these two agents is similar [SMD for JT = +0.23 (-0.30, +0.75), JS = +0.43 (-0.11, +0.96), FS = -0.27 (-0.80, +0.26), and WMD for ESR = -16.00 (-30.58, -1.42)].
Discussion: Based on the limited data available, moderate-term prednisone treatment of RA appears to be superior to placebo and comparable to treatment with aspirin or chloroquine in improving several common rheumatoid arthritis disease activity measures.
Methods: We conducted a search in MEDLINE from 1966 to 1998, using the keywords "corticosteroids" and "rheumatoid arthritis". We also handsearched all issues of Arthritis and Rheumatism and the Scandinavian Journal of Rheumatology from their dates of first publication to 1994. Furthermore, we examined all Arthritis and Rheumatism abstracts over the 15 year period preceding 1994. References of all identified studies were searched for relevant trials. Authors of unpublished manuscripts were contacted. Studies were selected by two independent reviewers (LC, KS) using a set of predetermined criteria. We considered randomized controlled trials (RCTs) of at least three months duration that used prednisone (or a comparable corticosteroid preparation) at a mean dosage of less than or equal to 15 mg/day. Statistical Analysis: We compared the efficacy of prednisone to placebo and/or active controls using a fixed effects model for continuous data. A Chi Square test for homogeneity was performed, and where heterogeneity existed a random effects model was used.
Results: Only seven of 34 studies identified by our search met the criteria for inclusion. Our results indicated that corticosteroids were significantly more effective than placebo controls for four of six outcomes assessed [standardized mean difference (SMD) for JT = -0.37 (95%CI: -0.59, -0.14), JS = -0.41 (-0.67, -0.16), pain = -0.43 (-0.74, -0.12), and FS = -0.57 (-0.92, -0.22)]. The results for GS and ESR were not significant [GS = +0.30 (-0.19, +0.80), weighted mean difference (WMD) for ESR = -7.03 (-18.06, +4.01)]. The single trial that compared prednisone to aspirin indicated no statistically significant difference between these groups for the two outcomes assessed [SMD for JT = +0.10 (-0.35, +0.55), WMD for ESR = 0.00 (-11.09, +11.09)]. Overall, the four outcomes assessed in the trial that compared prednisone to chloroquine suggested that the effectiveness of these two agents is similar [SMD for JT = +0.23 (-0.30, +0.75), JS = +0.43 (-0.11, +0.96), FS = -0.27 (-0.80, +0.26), and WMD for ESR = -16.00 (-30.58, -1.42)].
Discussion: Based on the limited data available, moderate-term prednisone treatment of RA appears to be superior to placebo and comparable to treatment with aspirin or chloroquine in improving several common rheumatoid arthritis disease activity measures.