Combination therapy with pulsed methylprednisolone in rheumatoid arthritis.

Neumann, Vera; Hopkins, R; Dixon, Jonathan S.; Watkins, Angela S.; Bird, H. A.; Wright, V.

doi:10.1136/ard.44.11.747

Cited by 34 publications

(6 citation statements)

References 5 publications

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“…Another possibility is that massive dosages of CS lead to a rapid loss of the readily exchangeable bone calcium owing to osteolysis by osteocytes,11 with a subsequent increase in serum Ca, followed by a gradual decrease as the readily exchangeable bone calcium stores are depleted.7 The slight increase in PTH and la,25(0H2)D3 in our study cannot be the result of stimulation by low serum Ca concentration but could be the result of a direct stimulation of PTH bW CS, as shown by sonlet2 but disputed by others. 3 It is clear from our limited data that the short term effects of high dose CS therapy differ from the known effects of long term CS therapy on bone metabolism. Perhaps the transient character may be caused by counter-regulatory effects, well known in the complicated processes of calcium homeostasis and bone metabolism.…”

Section: Discussionmentioning

confidence: 89%

Bone metabolism during methylprednisolone pulse therapy in rheumatoid arthritis.

Bijlsma¹,

Duursma²,

Huber-Bruning³

1986

Annals of the Rheumatic Diseases

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SUMMARY The deleterious effects of corticosteroids (CS) on bone are well known, but probably differ depending on duration and dosage of CS therapy. Presently huge amounts of CS are given over a short period of time in different rheumatic conditions. Not much is known about the effect of this kind of CS treatment on bone metabolism. Twenty patients with persistently active rheumatoid arthritis were treated with 1 g methylprednisolone (MP) three times on alternate days over a five day period. Twenty four hours after the first MP pulse serum calcium was increased and the values of parathyroid hormone and 1,25-dihydroxyvitamin D tended to increase. After the second MP pulse, however, these values had returned to the starting values. The urinary calcium excretion increased during MP pulse therapy and returned to the initial value immediately after the pulse therapy. The hydroxyproline excretion tended to decrease during therapy and stayed decreased immediately afterwards, indicating a decrease in bone resorption. It is concluded that bone metabolism is not seriously affected during MP pulse therapy.

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Section: Discussionmentioning

confidence: 89%

Bone metabolism during methylprednisolone pulse therapy in rheumatoid arthritis.

Bijlsma¹,

Duursma²,

Huber-Bruning³

1986

Annals of the Rheumatic Diseases

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“…The duration of the effect is relatively short (a few weeks), but can be extended sometimes by concomitant initiation of another remittiveagent (Neumann et al 1985;Smith et al 1988). The duration of the effect is relatively short (a few weeks), but can be extended sometimes by concomitant initiation of another remittiveagent (Neumann et al 1985;Smith et al 1988).…”

Section: Corticosteroidsmentioning

confidence: 99%

Rheumatoid Arthritis in the Aged

Nesher

Moore²

1993

Drugs & Aging

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Rheumatoid arthritis (RA) is estimated to occur in 0.3 to 3% of the general population. Up to one-third of RA patients first present for treatment after the age of 60 years (elderly-onset RA). The overall frequency in individuals older than 65 is increased, so that 30 to 40% of RA patients treated in rheumatology centres are > 60 years of age. Optimal management of all RA patients includes physical therapy, medications, both nonsteroidal anti- inflammatory drugs (NSAIDs) and remittive agents, and, in some cases, surgery. In the elderly, these treatment modalities at times need to be altered to accommodate age-related changes in body mechanics and organ function. Thus, the approach to physical therapy in older patients is different than in the young. There are fewer rest periods and more passive exercises. Drug treatment must also be modified, since NSAIDs and several remittive agents are more hazardous in elderly patients. Indications for orthopaedic procedures may also be different. The long term management of RA requires a delicate balance of benefit and risk. It is wise to begin with the least toxic medications. However, if necessary, potentially toxic medications can be given cautiously, with close monitoring for adverse effects.

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“…This is supported by randomized trials of pulse methylprednisolone that have demonstrated only brief (4-8 weeks) responses in most patients. 16 Previously published studies of Rituximab administration to patients with RA have been in the context of failure to methotrexate or other DMARDs. 5,17,12 The response of patients treated with cyclophosphamide and Rituximab by Edwards and Cambridge 5 appears to be more sustained than that demonstrated in this trial suggesting that the benefit of cyclophosphamide may be more potent closer to Rituximab administration rather than 2 years later, as in this study.…”

Section: Discussionmentioning

confidence: 99%