A Comparison of Prednisolone with Aspirin or other Analgesics in the Treatment of Rheumatoid Arthritis: M. R. C. Report

doi:10.1136/ard.18.3.173

Cited by 115 publications

(4 citation statements)

References 6 publications

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“…Clinical effectiveness and less joint damage were demonstrated. This study confirmed the results of the British Empire study 35 years earlier which apparently went unheeded [8]. Subsequently another 4 studies from Europe were published examining low dose prednisone versus placebo in early RA showing similar results including less joint damage [16][17][18][19].…”

Section: Discussionsupporting

confidence: 82%

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Prednisone on the threshold of rational use in the treatment of rheumatoid arthritis

Conn¹

2013

Health

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This is a review of the evolution of the use prednisone in the treatment of rheumatoid arthritis (RA). Cortisone was introduced in 1949 and shortly thereafter, the Mayo investigators found that low divided doses with slow tapering were effective and caused fewer side effects. In 1959, a British double blind 2 year study of prednisolone treatment in early RA demonstrated effectiveness and reduced bony erosions. This experience was lost over time and empiricism and efforts to reduce side effects dominated practice for the next 35 years. Since 1995, a number of controlled studies of low single daily doses of prednisone in early RA have been reported by European investigators. They have shown clinical improvement, reduced bony erosions, augmentation of the effect of dmards and few side effects. During the last 25 years, the molecular actions of glucocorticoids have been elucidated. The time relationship of the dose to the biologic and clinical effects has been established. As a result of the information on the diurnal effect of glucocorticoids and the documentation of the effect occurring 5-6 hours after the dose and dissipating by 24 hours, a delayed release preparation of prednisone has been developed. With the rediscovery of the effectiveness of low single daily morning dose of prednisone in early RA by controlled studies and the demonstration of the onset and duration of the clinical effect of low dose of prednisone, it is now possible to use low doses of prednisone rationally and effectively in the treatment of RA. It remains to be determined whether a single morning, single evening or a twice a day low dose is the most effective and safe. It is doubtful if the new delayed release prednisone is any more effective than the usual immediate release prednisone if given at the same time.

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Section: Discussionsupporting

confidence: 82%

“…L. Bywaters, conducted a double blind controlled 2 year study in early RA treated with prednisolone, initially 20 mg per day and then slowly tapered, or aspirin as controland was published in 1959. It showed clinical improvement and retardation of joint damage in the prednisolone treated patients [8].…”

Section: Discussionmentioning

confidence: 87%

Prednisone on the threshold of rational use in the treatment of rheumatoid arthritis

Conn¹

2013

Health

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“…In 1 study, 159 the 2 interventions (sulfapyridine and 5-aminosalicylic acid) were not connected to the network. The remaining 132 studies 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 …”

Section: Resultsmentioning

confidence: 99%

“…This may have contributed to a high, potentially exaggerated risk of bias assessment and to variability in presentation of outcomes, which made imputations necessary in 14 primary outcomes (10.6%). 22,24,25,27,[31][32][33]35,65,78,86,90,91,107 However, the TJC full analysis with imputed values showed similar results as the TJC analysis based on measured values.…”

Section: Limitationsmentioning

confidence: 94%

Monotreatment With Conventional Antirheumatic Drugs or Glucocorticoids in Rheumatoid Arthritis

Guski,

Jürgens,

Pedder

et al. 2023

JAMA Netw Open

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ImportanceThis is the first network meta-analysis to assess outcomes associated with multiple conventional synthetic disease-modifying antirheumatic drugs and glucocorticoid.ObjectiveTo analyze clinical outcomes after treatment with conventional synthetic disease-modifying antirheumatic drugs and glucocorticoid among patients with rheumatoid arthritis.Data SourcesWith no time restraint, English language articles were searched in MEDLINE, Embase, Cochrane Central, ClinicalTrials.gov, and reference lists of relevant meta-analyses until September 15, 2022.Study SelectionFour reviewers in pairs of 2 independently included controlled studies randomizing patients with rheumatoid arthritis to mono–conventional synthetic disease-modifying antirheumatic drugs, glucocorticoid, placebo, or nonactive treatment that recorded at least 1 outcome of tender joint count, swollen joint count, erythrocyte sedimentation rate, and C-reactive protein level. Of 1098 assessed articles, 130 articles (132 interventions) were included.Data Extraction and SynthesisThe review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and data quality was assessed by the Cochrane risk of bias tool RoB 2. Data were extracted by a single author and checked independently by 2 authors. Data were analyzed using a random effect model, and data analysis was conducted from June 2021 to February 2023.Main Outcomes and MeasuresA protocol with hypothesis and study plan was registered before data recording. The most complete of recorded outcomes (tender joint count) was used as primary outcome, with imputations based on other outcomes to obtain a full analysis of all studies. Absolute change adjusted for baseline disease activity was assessed.ResultsA total of 29 interventions in 275 treatment groups among 132 randomized clinical trials (mean [range], 71.0% [27.0% to 100%] females in studies; mean [range] of ages in studies, 53 [36 to 70] years) were identified, which included 13 260 patients with rheumatoid arthritis. The mean (range) duration of RA was 79 (2 to 243) months, and the mean (range) disease activity score was 6.3 (4.0 to 8.8). Compared with placebo, oral methotrexate was associated with a reduced tender joint count by 5.18 joints (95% credible interval [CrI], 4.07 to 6.28 joints). Compared with methotrexate, glucocorticoid (−2.54 joints; 95% CrI, −5.16 to 0.08 joints) and remaining drugs except cyclophosphamide (6.08 joints; 95% CrI, 0.44 to 11.66 joints) were associated with similar or lower tender joint counts.Conclusions and RelevanceThis study’s results support the present role of methotrexate as the primary reference conventional synthetic disease-modifying antirheumatic drug.

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Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis

Pc¹,

Johansen²

1998

The Cochrane Database of Systematic Reviews

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A Comparison of Prednisolone with Aspirin or other Analgesics in the Treatment of Rheumatoid Arthritis: M. R. C. Report

Cited by 115 publications

References 6 publications

Prednisone on the threshold of rational use in the treatment of rheumatoid arthritis

Prednisone on the threshold of rational use in the treatment of rheumatoid arthritis

Monotreatment With Conventional Antirheumatic Drugs or Glucocorticoids in Rheumatoid Arthritis

Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis

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